Yamamoto N

Prognosis of Japanese Metastatic Renal Cell Carcinoma Patients in the Cytokine Era: A Cooperative Group Report of 1463 Patients

BACKGROUND Incidence rate of renal cell carcinoma (RCC) differs among countries. The rates of Asian countries are lower than those of countries in North America or Europe but are exceptionally high in Japanese males. Approximately 30% of patients with RCC have metastasis at initial diagnosis, and another 30% have metastasis after nephrectomy. Clinical studies of risk factors in patients with metastatic RCC (mRCC) are mainly based on data from non-Asian patients. OBJECTIVES We aimed to investigate the prognosis of Japanese patients and their prognostic factors. DESIGN, SETTING, AND PARTICIPANTS The subjects of this study were 1463 patients who were clinically diagnosed with RCC with metastasis in 40 Japanese hospitals between January 1988 and November 2002. MEASUREMENTS The primary end point was overall survival calculated from first diagnosis of mRCC to death or last follow-up. We also investigated the relationship between survival and clinical features. RESULTS AND LIMITATIONS The median overall survival time was 21.4 mo. The estimated survival rates at 1, 3, 5, and 10 yr were 64.2%, 35.2%, 22.5%, and 9.1%, respectively; they contrasted with data from the United States of 54%, 19%, 10%, and 6%, respectively for the same periods. A high percentage of patients had undergone nephrectomy (80.5%) and metastasectomy (20.8%), both of which were shown to prolong survival. CONCLUSIONS The median survival time in the present study was approximately twice as long as that of previous studies from North America or Europe. Early diagnosis of metastasis, nephrectomy, metastasectomy, and cytokine-based therapy seemed to improve the prognosis of RCC patients in the present study.

Bacillus Calmette-Guérin instillation treatment for carcinoma in situ of the upper urinary tract.

Objective To analyse the efficacy and safety of bacillus Calmette–Guérin (BCG) perfusion treatment forcarcinoma in situ (CIS) of the upper urinary tract.

Utility of Bcl-2, P53, Ki-67, and caveolin-1 immunostaining in the prediction of biochemical failure after radical prostatectomy in a Japanese population.

OBJECTIVES To identify predictive markers for biochemical failure after radical prostatectomy in patients with clinically confined prostate cancer. METHODS Immunohistochemistry of bcl-2, p53, Ki-67, and caveolin-1 was performed in samples of paraffin-embedded prostate cancer from 119 Japanese patients. The clinicopathologic significance of staining with these markers was analyzed in relation to biochemical failure (prostate-specific antigen [PSA] >0.2 ng/mL). RESULTS Univariate analysis showed the pretreatment PSA level (P = 0.03), postoperative Gleason score (P = 0.04), pathologic stage (P <0.001), seminal vesicle invasion (P <0.001), p53 staining (P <0.001), Ki-67 staining (P = 0.04), and caveolin-1 staining (P <0.0001) to be associated with biochemical failure. Multivariate Cox proportional hazards modeling showed that pretreatment PSA in group A (clinicopathologic parameters), caveolin-1 staining in group B, biomarkers, and the combination (group C) were independently associated with prediction of biochemical failure. The accuracy rate of each group was 76.2% (group A), 75.1% (group B), and 83.1% (group C), respectively. CONCLUSIONS The combination of clinicopathologic parameters and biomarkers (group C) showed the highest accuracy rate. Caveolin-1 staining is an independent predictor of biochemical failure after radical prostatectomy.

Nucleolar organizer regions in rat urinary bladder tumors induced by N-butyl-N-(4-hydroxybutyl)nitrosamine

SummaryThe number of nucleolar organizer regions (NORs) stained by the one-step silver colloid method was measured in preneoplastic and neoplastic bladder lesions induced by N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) in rats. Male ACI/N rats, 6 weeks of age, were given 0.05% BBN in drinking water for 5, 8, 12, 18 and 30 weeks to induce preneoplastic and neoplastic transitional cell lesions. The mean numbers of silverstained NORs (AgNORs) in such lesions were as follows: untreated transitional epithelium (n = 6), 1.26 ±0.09; transitional cell epithelium outside focal lesions (n= 10), 1.75 ±0.10; simple hyperplasia (n= 10), 2.01 ±0.15; papillary or nodular (PN) hyperplasia (n= 10), 2.15±0.19; transitional cell papilloma (n= 5), 2.37 ±0.12; transitional cell carcinoma (n= 5), 3.52 ±0.23. Thus, the mean number of AgNORs showed a step-wise increase from untreated and treated, histologically normal transitional epithelium through simple hyperplasia and PN hyperplasia to transitional cell papilloma and carcinoma. These results suggest that the mean number of AgNORs may reflect the proliferative nature of bladder lesions induced by BBN, as reported in preneoplastic and neoplastic lesions in other organs. PN hyperplasias were classified into two types based upon the mean number of AgNORs, indicating that they include reversible and irreversible changes in contrast with simple hyperplasia which is reversible change.

Significance of AgNOR counts for distinguishing carcinoma from adenoma and hyperplasia in parathyroid gland

Nucleolar organizer region proteins, which can be stained and visualized by an argyrophil technique (AgNORs), are markers of cell activities, such as DNA transcription and proliferation, and they are useful for differential diagnosis between benign and malignant tumors. We counted both AgNOR numbers in 25 parathyroid lesions (three carcinomas, 11 adenomas, 10 hyperplasias, and one hyperplasia with carcinoma) to determine if the AgNOR number could be useful as a diagnostic aid in parathyroid neoplasms and hyperplasias, because it is often difficult to histopathologically distinguish among these lesions. The AgNOR numbers were significantly higher in carcinomas (3.18 +/- 0.05) than in adenomas (1.67 +/- 0.30, P < .001) or hyperplasias (1.85 +/- 0.16, P < .001), but there was no significant difference between adenomas and hyperplasias. These results suggest that AgNORs may be useful as an adjunct to discriminating carcinomas from adenomas or hyperplasias in the parathyroid gland.

A pretreatment nomogram predicting recurrence- and progression-free survival for nonmuscle invasive bladder cancer in Japanese patients

PurposeOur aim was to provide nomograms that allow urologists to easily calculate a nonmuscle invasive bladder cancer patient’s risk of recurrence and progression.Materials and methodsWe retrospectively analyzed 800 nonmuscle invasive bladder cancer patients newly diagnosed between 1991 and 2001 from the Gifu urothelial cancer registry program. We developed the nomogram using the original 500 patients and validated it using the remaining 300 patients. The prognostic factors of recurrence and progression were identified by multivariate analysis in 500 patients.ResultsIn the multivariate analysis, tumor number, shape, grade, and intravesical instillation were associated with recurrence-free survival. Tumor shape and grade were associated with progression-free survival. Six factors for recurrence and three factors for progression were used to make the nomogram. Using the original 500 patients who were modeled for the nomogram, the areas under the receiver operating characteristic curves (AUCs) were calculated to be 0.61 for recurrence and 0.71 for progression. To validate nomogram performance, we applied an additional 300 patients to the nomograms. The AUCs were 0.57 for recurrence and 0.67 for progression.ConclusionsThe nomograms that have been developed can be used to predict the probability of recurrence and progression of nonmuscle invasive bladder cancer.

Müllerian duct cyst extending into the abdomen

Müllerian duct cysts occupying the pelvic/abdominal region are rare. We describe a müllerian duct cyst extending into the lower abdomen in a 47-year-old man complaining of urinary retention. We removed the cyst through a suprapubic retrovesical approach. No malignancy was found in the surgical specimen.

Nucleolar Organizer Regions in Prostate Cancer

A silver colloid technique for the staining of nucleolar organizer regions (NORs) was applied to paraffin sections of 52 clinical prostate cancers, 5 incidental carcinomas of the prostate, 12 benign prostatic hypertrophy (BPH) specimens and 7 normal prostates. The mean numbers of silver-stained NORs (AgNORs) in these lesions were 3.12 +/- 0.52 in clinical cancer, 2.65 +/- 0.64 in incidental cancer, 1.66 +/- 0.16 in BPH, and 1.76 +/- 0.22 in normal prostate. There was a statistically significant difference in agNORs numbers between cancer and benign prostatic tissues (p < 0.001). However, no significant difference was observed in AgNORs numbers between incidental and clinical carcinoma of the prostate. In clinical cancer, only poorly differentiated adenocarcinoma showed a statistically larger number of AgNORs than the well or moderately differentiated group (p < 0.02). Correlation between AgNORs numbers and clinical stage was not obvious. There was no relationship between the number of AgNORs and serum values of tumor markers such as PAP, PSA and gamma-Sm. Moreover, the AgNORs numbers did not show a relation to decreasing rates of serum marker levels during successful anti-androgen therapy. If the patients with prostate cancer were divided into two groups by 2.9 of AgNORs number, the group with the smaller number of AgNORs (n = 14) was found to have a tendency towards a longer disease-stabilizing period than the larger group (n = 17).

Primitive neuroectodermal tumor of the kidney confirmed by fluorescence in situ hybridization

We report a rare case of primitive neuroectodermal tumor of the kidney. The diagnosis was confirmed by the immunohistochemical profile and fluorescence in situ hybridization in formalin-fixed, paraffin-embedded tissues. The patient received intensive chemoradiotherapy after radical surgery and remains alive without recurrence 1 year after initial presentation.

Intra-arterial chemotherapy using a reservoir for endocrine-refractory prostate cancer

For local control in patients with endocrinerefractory prostate cancer, an intra-arterial chemotherapy regimen comprising methotrexate (MTX), Adriamycin (ADM), and cisplatin (CDDP) was evaluated. A total of 19 patients having a mean age of 66.4±8.8 years and a mean performance status (PS) of 1.3±1.0 were enrolled. Of these patients, 3 had proved to be resistant to initial endocrine therapy and the remaining 16 had relapsed from disease stabilization after endocrine therapy. The catheter tip was placed in the internal iliac artery in 16 cases, in the common iliac artery in 2 cases, and in the aorta in 1 case after occlusion of the contralateral feeding artery. The intra-arterial chemotherapy was performed mainly using MTX (30 mg/m2), ADM (30 mg/m2), and CDDP (50 mg/m2) as one course and was repeated for a mean of 2.9±2.3 courses. Then, in an outpatient clinic, 5-fluorouracil (5-FU), ADM, or MTX was given intra-arterially as maintenance chemotherapy until re-relapse. As based on the criteria for evaluation of nonsurgical therapy in prostate cancer proposed by the Japanese Urological Association, the prostatic lesion showed a partial response (PR) in 9 cases and no change (NC) in 10 cases. As judged from the response of prostate-specific antigen (PSA), a complete response (CR) was obtained in 6 cases, a PR, in 3 cases; and NC and progressive disease (PD), in 2 cases each. Therefore, the overall response rate was 63%. Improvement in the symptoms was observed in 83% of patients. The duration of the response was 15.1±10.5 months for the PR cases and 7.4±5.7 months for the NC cases. Furthermore, the mean survival time observed in the PR group was 38.9 months, which was better than that seen in the NC (16.4 months) and PD (10.5 months) groups. These results suggest that intra-arterial chemotherapy may become and option for the treatment of locally advanced and endocrine-refractory prostate cancers. Using a reservoir, this chemotherapy can be easily given in an outpatient clinic.