Ryoji Kimata

Snail expression and outcome in T1 high-grade and T2 bladder cancer: a retrospective immunohistochemical analysis

BackgroundNeoadjuvant chemotherapy has been shown to have benefit in T1 high-grade or T2 bladder cancer. However, neoadjuvant chemotherapy fails in some patients. Careful patient selection for neoadjuvant chemotherapy is therefore needed. Several reports show that Snail is associated with resistance to chemotherapy. We hypothesized that Snail expression could predict survival in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy.MethodsThe participants were 44 patients with T1 high-grade and T2 bladder cancer receiving neoadjuvant chemotherapy. Immunohistochemical analysis was used to determine Snail expression in specimens of bladder cancer obtained by transurethral resection before neoadjuvant chemotherapy. The relationships between Snail expression and patients’ outcomes were analyzed.ResultsSnail expression was positive in 15 of the 44 patients (34.1%) and negative in 29 (65.9%). Disease-free survival was significantly shorter for the Snail-positive group than for the Snail-negative group (p = 0.014). In addition, disease-specific survival was also significantly shorter for the Snail-positive group than for the Snail-negative group (p = 0.039). In multivariate analysis, Snail expression level was identified as an independent prognostic factor for disease-specific survival (p = 0.020).ConclusionsThe results indicate that Snail expression may predict poor outcome in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy.

Negative-balance isolated pelvic perfusion in patients with incurable symptomatic rectal cancer: results and drug dose correlation to adverse events

Background Drug leakage and lack of a drug-removal system have prevented clinical application of isolated pelvic perfusion (IPP). These barriers were overcome with negative-balance IPP (NIPP) in experimental pig models. Here, a phase 1 clinical study of NIPP was performed in patients with incurable symptomatic rectal cancer. Purpose To establish a safe regimen of high-dose regional chemotherapy with NIPP using cisplatin in patients with incurable rectal cancer. Material and Methods Between June 2004 and January 2007, NIPP therapy was performed for 23 patients (11 women, 12 men; mean age, 58 years). NIPP was routinely performed twice over a 4-week interval. Dose-limiting toxicities (DLTs) were defined using a 5 + 3 design, and cisplatin doses were escalated from 170 mg/m2, with a fixed 5-fluorouracil dose of 1000 mg/m2. The grade of adverse events (AEs) at the first and second sessions of NIPP therapy, pharmacokinetics, and antitumor response were evaluated. Results No DLTs were observed during the first session of NIPP. However, at the second session, two patients experienced the DLT of neuropathy after administration of 200 mg/m2 cisplatin. Therefore, 190 mg/m2 cisplatin was indicated as the maximum tolerated dose (MTD). The plasma pelvic-to-systemic exposure ratio was 18.4 based on the maximum concentration and 19.0 based on the concentration-time curve. Solid tumor responses included complete response in two patients, partial response in five patients, stable disease in 15 patients, and progressive disease in one patient. Conclusion NIPP may offer the safe delivery of high-dose regional chemotherapy (MTD of 190 mg/m2 cisplatin) with negligible AEs and effective control of tumor growth in patients with incurable rectal cancer.

Efficacy of a thermoexpandable metallic prostate stent (Memokath) in elderly patients with urethral obstruction requiring long‐term management with urethral Foley catheters

To investigate whether the insertion of a thermoexpandable metallic prostate stent (Memokath) facilitates the removal of Foley catheters in elderly patients ineligible for urethral obstruction surgery because of the potential complications involved in long‐term catheter management.

MP22-03 DUAL-SPECIFICITY TYROSINE PHOSPHORYLATION-REGULATED KINASE 2 AS A NOVEL MARKER IN BLADDER CANCER PATIENTS RECEIVING NEOADJUVANT CHEMOTHERAPY

(Pinteraction 1⁄4 0.609). Among individuals with GSTM1 null and present genotypes, the corresponding ORs were 2.91 (95% CI, 0.44-19.09) and 4.21 (95% CI, 1.26-14.14), respectively (Pinteraction 1⁄4 0.712). CONCLUSIONS: Our findings support the hypothesis that genetic factors play a role in bladder cancer etiology. Whether these correspond to low-penetrance cancer-predisposing polymorphisms acting together and/or interacting with environmental factors warrants further research.

Intra-arterial Combination Chemotherapy with Maximum Transurethral Resection of Bladder Tumour for T1 Grade 3 and T2--3N0M0 BladderCancers

Purpose: We evaluated the clinical outcomes following intra-arterial chemotherapy with maximum transurethral resection of bladder tumour (TURBT) for patients with T1 grade 3 (G3) and T2--3N0M0 bladder cancers. Material and methods: Patients were 27 males and 7 females with a median age of 63.6 years. With the cooperation of an interventional radiologist, cisplatin (100 mg/m2), methotrexate (30 mg/m2) and adriamycin (20 mg/ body) were administered via a catheter in 2 cycles every 4 weeks. Results: The 5-year cancer-specific survival rate in T1 G3, T2 and T3 was 100.0%, 57.3% and 50.0%, respectively. In T2--3N0M0 cases, complete response (CR) and non-CR were seen in 13 (46.4%) and 15 cases (53.6%), respectively. Response to treatment proved to be the most significant prognostic predictor of cancerspecific survival by multivariate analysis in T2--3N0M0 cases. T2--3N0M0 cases with ?2 prognostic predictors at staging TURBT (age >70 years, male, size >3 cm and the presence of hydronephrosis) had an unfavourable outcome. There was a statistical association between the number of prognostic predictors at staging TURBT and response to treatment. Conclusion: These results suggest that our protocol prevents disease progression in T1 G3 cases, but that it is not suitable for T2--3N0M0 cases with ?2 prognostic predictors at staging TURBT.