Umeda, Kota



School of Medicine, Department of Urology (Shinanomachi)




Papers 【 Display / hide

  • Site-Specific Differences in PD-1 Blockade Success and Biomarkers in Urothelial Carcinoma Treated with Pembrolizumab.

    Umeda K, Tanaka N, Yasumizu Y, Takeda T, Matsumoto K, Morita S, Kosaka T, Mizuno R, Oya M

    Clinical genitourinary cancer (Clinical Genitourinary Cancer)  21 ( 1 ) 128 - 135 2022.08

    ISSN  1558-7673

     View Summary

    Introduction: Since tumors in different human organs may have different tumor microenvironments, we evaluate time-course changes in all tumor locations after pembrolizumab treatment in urothelial carcinoma (UC) to examine the differences in efficacy of pembrolizumab per organ. Further, we uncover the usefulness of inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), CRP, and kinetics of these markers to predict pembrolizumab success and relation to overall survival (OS) in UC. Patients and Methods: A total of 115 cancerous lesions from 44 UC patients were measurable based on RECIST 1.1 criteria. The serum CRP and NLR levels were measured at baseline prior to pembrolizumab treatment and at least every 3 weeks just prior to pembrolizumab administration. Results: Site-specific success (ie, patients with CR/PR/SD by RESIST 1.1) rates for pembrolizumab treatments were as follows: primary tumors: 67%, lymph node: 70%, lung: 44%, liver: 40%, and peritoneal metastasis: 56%. Focusing on the major metastasis sites, lymph nodes and lungs, we examined the relationships between NLR, CRP, or that kinetics and pembrolizumab success. In lymph nodes, both early NLR kinetics (P = .005) and CRP kinetics (P = .035) was a predictor for pembrolizumab success. On the other hand, none of 4 was not in lung metastases. Regarding to the mortality, the multivariate analysis revealed that early NLR kinetics was a prognostic biomarker for OS among the 4, independent of performance status and liver metastasis. Conclusion: We revealed that site-specific pembrolizumab success in UC. Early NLR kinetics was a predictor for lymph node pembrolizumab success and OS in our cohorts.

  • A low subcutaneous fat mass is a risk factor for the development of inguinal hernia after radical prostatectomy

    Umeda K., Takeda T., Hakozaki K., Yasumizu Y., Tanaka N., Matsumoto K., Morita S., Kosaka T., Mizuno R., Asanuma H., Oya M.

    Langenbeck's Archives of Surgery (Langenbeck's Archives of Surgery)  407 ( 7 ) 3107 - 3112 2022

    ISSN  14352443

     View Summary

    Purpose: Inguinal hernia (IH) after radical prostatectomy (RP) is a complication that impairs quality of life; however, the factors contributing to IH after RP remain unclear. Therefore, we herein attempted to identify the factors responsible for the development of IH after RP. Methods: We reviewed 622 patients who underwent laparoscopic or robot-assisted laparoscopic RP at our hospital between December 2011 and April 2020. The total fat area and visceral fat area were calculated at the level of the umbilicus using computed tomography, and the subcutaneous fat area (SFA) was calculated by subtracting the visceral fat area from the total fat area. The psoas muscle area was measured at the third lumbar vertebrae level using computed tomography to calculate the psoas muscle mass index, which is used in sarcopenia as an index of muscle mass. We investigated the risk factors for IH after laparoscopic or robot-assisted laparoscopic RP. Results: IH developed in 88 patients (16.7%). Fifty-seven of these patients underwent hernia repair at our hospital, and 56 (98.2%) had indirect hernias. A multivariate analysis identified SFA (odds ratios: 0.383, p < 0.001) as an independent predictor for the development of IH. Two-year IH-free survival rates were 77.3% in the small SFA group (SFA < 123 cm2) and 88.7% in the large SFA group (SFA ≥ 123 cm2) (p < 0.001). Conclusion: Subcutaneous fat was associated with the development of IH, particularly indirect IH, after laparoscopic or robot-assisted laparoscopic RP. An indirect IH prevention technique needs to be considered, particularly for patients with less subcutaneous fat.

  • The clinicopathological characteristics of muscle-invasive bladder recurrence in upper tract urothelial carcinoma

    Shigeta K., Matsumoto K., Ogihara K., Murakami T., Anno T., Umeda K., Izawa M., Baba Y., Sanjo T., Shojo K., Tanaka N., Takeda T., Kosaka T., Mizuno R., Mikami S., Kikuchi E., Oya M.

    Cancer Science (Cancer Science)  112 ( 3 ) 1084 - 1094 2021.03

    ISSN  13479032

     View Summary

    This study aimed to clarify the clinical characteristics and oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) who developed muscle-invasive bladder cancer (MIBC) after radical nephroureterectomy (RNU). We identified 966 pTa-4N0-2M0 patients with UTUC who underwent RNU and clarified the risk factors for MIBC progression after initial intravesical recurrence (IVR). We also identified 318 patients with primary pT2-4N0-2M0 MIBC to compare the oncological outcomes with those of patients with UTUC who developed or progressed to MIBC. Furthermore, immunohistochemical examination of p53 and FGFR3 expression in tumor specimens was performed to compare UTUC of MIBC origin with primary MIBC. In total, 392 (40.6%) patients developed IVR after RNU and 46 (4.8%) developed MIBC at initial IVR or thereafter. As a result, pT1 stage on the initial IVR specimen, concomitant carcinoma in situ on the initial IVR specimen, and no intravesical adjuvant therapy after IVR were independent factors for MIBC progression. After propensity score matching adjustment, primary UTUC was a favorable indicator for cancer-specific death compared with primary MIBC. Subgroup molecular analysis revealed high FGFR3 expression in non-MIBC and MIBC specimens from primary UTUC, whereas low FGFR3 but high p53 expression was observed in specimens from primary MIBC tissue. In conclusion, our study demonstrated that patients with UTUC who develop MIBC recurrence after RNU exhibited the clinical characteristics of subsequent IVR more than those of primary UTUC. Of note, MIBC subsequent to UTUC may have favorable outcomes, probably due to the different molecular biological background compared with primary MIBC.

  • Does neoadjuvant chemotherapy have therapeutic benefit for node-positive upper tract urothelial carcinoma? Results of a multi-center cohort study

    Shigeta K., Matsumoto K., Ogihara K., Murakami T., Anno T., Umeda K., Izawa M., Baba Y., Sanjo T., Shojo K., Tanaka N., Takeda T., Morita S., Kosaka T., Mizuno R., Arita Y., Akita H., Jinzaki M., Kikuchi E., Oya M.

    Urologic Oncology: Seminars and Original Investigations (Urologic Oncology: Seminars and Original Investigations)  40 ( 3 ) 105.e19 - 105.e26 2021

    ISSN  10781439

     View Summary

    Objective: The indications of neoadjuvant chemotherapy (NAC) for lymph node-positive upper tract urothelial carcinoma (UTUC) have not been investigated regarding improved survival outcomes. Our specific aim was to compare the clinical outcomes of clinically node-positive UTUC patients who were treated by NAC followed by radical nephroureterectomy (RNU) or upfront RNU followed by adjuvant chemotherapy (AC). Materials and methods: Among 966 UTUC patients, we identified 89 with clinical nodal involvement who received either NAC before RNU nor AC after upfront RNU. Cox proportional hazard models were employed to evaluate the impact of chemotherapy modality on the oncological outcomes. Results: Of the patient cohort, 36 (40.4%) received NAC followed by RNU, whereas 53 (59.6%) underwent RNU followed by AC. Multivariate analysis revealed that tumor size ≥3 cm, clinical T4, and gemcitabine and cisplatin regimen were independent risk factors for disease recurrence, whereas NAC followed by RNU was an independent factor for favorable RFS. Furthermore, regarding cancer-specific survival (CSS), NAC followed by RNU remained an independent factor for favorable CSS. According to Kaplan-Meier analysis, the 1-year and 2-year RFS were 67.9% and 47.0%, respectively, in the NAC+RNU group, which were significantly higher than those in the RNU+AC group (43.9% and 24.6%, respectively, P = 0.006). Moreover, the 1-year and 2-year CSS were 80.5% and 64.2%, respectively, in the NAC+RNU group, which were higher than those in the RNU+AC group (68.6% and 48.2%, respectively, P = 0.016). Conclusion: For node-positive UTUC patients, NAC followed by RNU was more clinically beneficial than RNU followed by AC.

  • A Novel Risk-based Approach Simulating Oncological Surveillance After Radical Nephroureterectomy in Patients with Upper Tract Urothelial Carcinoma

    Shigeta K., Kikuchi E., Abe T., Hagiwara M., Ogihara K., Anno T., Umeda K., Baba Y., Sanjo T., Shojo K., Mikami S., Mizuno R., Oya M.

    European Urology Oncology (European Urology Oncology)  3 ( 6 ) 756 - 763 2020.12

     View Summary

    Background: The current guideline lacks evidence for creating individualized surveillance strategies for upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). Objective: To create a novel risk model and to simulate individualized surveillance duration that dynamically illustrates the changing risk relationship of UTUC-related death and non-UTUC death, considering the impact of cigarette smoking. Design, setting, and participants: This multicenter cohort study comprised 714 pTa-T4N0M0 UTUC patients, with a median follow-up duration of 65 mo. There were 279 (39.1%) nonsmokers, 260 (36.4%) current smokers, and 175 (24.5%) ex-smokers. Intervention: All patients underwent RNU. Outcome measurements and statistical analysis: The risks of UTUC death and non-UTUC death over time were estimated using parametric models for time to failure with Weibull distributions. Age-specific, stage-specific, and smoking status-specific surveillance durations were simulated based upon Weibull estimates. Results and limitations: The hazard rate (HR) of non-UTUC death gradually increased over time in all age groups regardless of the smoking status, whereas that of UTUC-related death decreased markedly according to the pathological T (pT) stage and was affected by the smoking status. Among current smokers, the baseline HR of UTUC-related death in pT3/4 was higher than that of pT ≤2 and remained high even 10 yr after RNU. Among heavy smokers, the HR of UTUC-related death in all pT stages was highest at baseline and remained high after RNU, compared with nonsmokers, current smokers, or ex-smokers. We simulated specific time points when the risk of non-UTUC death was greater than that of UTUC-related death. Among patients ≥80 yr of with pT3N0M0, the risk of non-UTUC death was greater than that of UTUC-related death 1 yr after RNU in nonsmokers, but 7 yr for heavy smokers. Conclusions: Our result revealed that smokers bear a long-term risk burden of UTUC-related death more than the risk of non-UTUC death. For UTUC smokers, longer-term surveillance duration is recommended even in elderly stage. Patient summary: In the present study, we evaluated the risk transition of upper tract urothelial carcinoma (UTUC)-related death and non-cancer-related death over time. We found that smoking weighed a huge impact upon UTUC-related death compared with death from other cause, and therefore, we created a more individualized surveillance duration model.

display all >>

Reviews, Commentaries, etc. 【 Display / hide

  • 若手泌尿器外科医に対するロボット支援下前立腺全摘除術のラーニングカーブ評価(Evaluating the Learning Curve of Robot Assisted Radical Prostatectomy for Young Urology Surgeons)

    竹内 玲衣, 茂田 啓介, 梅田 浩太, 勝井 政博, 福本 桂資郎

    西日本泌尿器科学会総会抄録集 ((一社)西日本泌尿器科学会)  74回   171 - 171 2022.11

  • 右腎細胞癌術後の対側尿管転移に対し、腹腔鏡下尿管部分切除術で腎温存した1例

    勝井 政博, 服部 盛也, 竹内 玲衣, 梅田 浩太, 茂田 啓介, 福本 桂資郎, 折笠 英紀, 原 智

    日本泌尿器内視鏡・ロボティクス学会総会 ((一社)日本泌尿器内視鏡・ロボティクス学会)  36回   AV - 4 2022.11

  • 腹腔鏡下手術教育:指導する側される側 慶應義塾大学における腹腔鏡下手術教育の取り組み

    武田 利和, 梅田 浩太, 安水 洋太, 田中 伸之, 松本 一宏, 森田 伸也, 小坂 威雄, 水野 隆一, 浅沼 宏, 大家 基嗣

    日本泌尿器科学会総会 ((一社)日本泌尿器科学会総会事務局)  109回   SY35 - 1 2021.12

  • 前立腺全摘除術後の鼠径ヘルニアの発症と皮下脂肪量の関連

    梅田 浩太, 武田 利和, 箱崎 恭平, 安水 洋太, 田中 伸之, 松本 一宏, 森田 伸也, 小坂 威雄, 水野 隆一, 浅沼 宏, 大家 基嗣

    日本泌尿器科学会総会 ((一社)日本泌尿器科学会総会事務局)  109回   PP62 - 09 2021.12

  • 皮下脂肪量は前立腺全摘除術後の鼠径ヘルニア発症に影響を及ぼす

    梅田 浩太, 武田 利和, 安水 洋太, 田中 伸之, 松本 一宏, 森田 伸也, 小坂 威雄, 水野 隆一, 浅沼 宏, 大家 基嗣

    日本泌尿器内視鏡学会総会 ((一社)日本泌尿器内視鏡・ロボティクス学会)  35回   P - 8 2021.11

display all >>

Research Projects of Competitive Funds, etc. 【 Display / hide

  • 膀胱がんにおけるlong non-coding RNAが担う役割の解明


    基盤研究(C), Principal investigator

  • long non-coding RNAが果たす膀胱がんでの働きの解明


    MEXT,JSPS, Grant-in-Aid for Scientific Research, Grant-in-Aid for Early-Career Scientists , Principal investigator