研究者詳細 - 大家　基嗣

論文 - 大家　基嗣

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Angiomyolipoma with epithelial cysts of the kidney in a man

Mikami Shuji, Oya Mototsugu, Mukai Makio

PATHOLOGY INTERNATIONAL 58 （ 10 ） 664 - 667 2008年10月

研究論文（学術雑誌）, 共著, ISSN 1320-5463

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The novel NF-κB activation inhibitor dehydroxymethyl-epoxyquinomicin suppresses anti-thy1.1-induced glomerulonephritis in rats

Kosaka Takeo, Miyajima Akira, Kikuchi Eiji, Horiguchi Yutaka, Umezawa Kazuo, Ohigashi Takashi, Nakashima Jun, Asano Tomohiko, Oya Mototsugu

Nephron - Experimental Nephrology 110 （ 1 ） 2008年09月

ISSN 1660-2129

Background: NF-κB participates in the transcriptional regulation of numerous genes, and many studies have confirmed the activation of NF-κB in inflammatory renal diseases. Therefore, NF-κB is a promising target for the treatment of these diseases. We tested the effects of dehydroxymethyl- epoxyquinomicin (DHMEQ), a novel NF-κB activation inhibitor, on anti-thy1.1 antibody-induced glomerulonephritis (Thy1.1 GN). Methods: Thy1.1 GN was induced in Sprague-Dawley rats (6/group) by intravenous injection of anti-thy 1.1 antibody. The effects of DHMEQ (8 mg/kg/day) on the glomerular disease were evaluated using periodic acid-Schiff and Masson trichrome stains, immunohistochemistry for proliferating cell nuclear antigen, fibronectin and CD45 (leukocyte common antigen) and TUNEL staining. NF-κB activation was analyzed by a fluorescent electrophoretic mobility shift assay. Results: On day 7, DHMEQ treatment resulted in marked inhibition of NF-κB, decreased proteinuria (223.2 ± 42.3 vs. 434.8 ± 16.5 mg/kg/day, p < 0.05), preserved creatinine clearance (1.93 ± 0.38 vs. 1.07 ± 0.29 l/day, p < 0.01), decreased glomerular cell proliferation (15.8 ± 1.2 vs. 31.2 ± 0.8 nuclei/glomerular cross-section) and mesangial matrix deposition, and an increase in glomerular and tubular apoptosis without inducing any obvious adverse effects. Conclusion: DHMEQ inhibited NF-κB and thereby suppressed the inflammatory renal responses in rats with Thy1.1 GN.

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Decreased Acetylation of Histone H3 in Renal Cell Carcinoma

Kanao Kent, Mikami Shuji, Mizuno Ryuichi, Shinojima Toshiaki, Murai Masaru, Oya Mototsugu

Journal of Urology 180 （ 3 ） 1131 - 1136 2008年09月

ISSN 0022-5347

Purpose: Recent studies suggest that alterations in chromatin structure by histone acetylation may have an important role in the neoplastic process. We evaluated histone H3 acetylation in renal cell carcinoma and the effects of a histone deacetylase inhibitor on renal cancer cell lines. Materials and Methods: The expression of acetylated histone H3 (Lys9) in renal cell carcinoma and corresponding nonneoplastic tissue specimens was evaluated. We next assessed immunohistologically the relationships between acetylated histone H3 expression and clinicopathological parameters in 44 cases of renal cell carcinoma. Furthermore, we evaluated the effects of the histone deacetylase inhibitor depsipeptide on the renal cancer cell lines Caki-1, ACHN, 769P and 786O (ATCC®). Results: Acetylated histone H3 expression was decreased in 85.0% of renal cell carcinomas compared to levels in nonneoplastic tissue. Decreased expression was related to high nuclear tumor grade and advanced pathological tumor stage (p = 0.048 and 0.032, respectively). Depsipeptide inhibited cell line proliferation in a time and dose dependent manner. Depsipeptide induced apoptosis in Caki-1, ACHN and 786O, and induced G2 cell cycle arrest in 769P. Concomitantly depsipeptide increased acetylated histone H3 and p21^WAF/CIP1 expression, and induced Bcl-2 phosphorylation. Conclusions: These results suggest that the decreased acetylation of histone H3 is a common alteration in a malignant phenotype of renal cell carcinoma. Increasing the amount of acetylated histone H3 might be a therapeutic option for renal cell carcinoma.

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Prediction of extraprostatic extension by prostate specific antigen velocity, endorectal MRI, and biopsy Gleason score in clinically localized prostate cancer

Nishimoto Koshiro, Nakashima Jun, Hashiguchi Akinori, Kikuchi Eiji, Miyajima Akira, Nakagawa Ken, Ohigashi Takashi, Oya Mototsugu, Murai Masaru

International Journal of Urology 15 （ 6 ） 520 - 523 2008年06月

ISSN 0919-8172

Objectives: To investigate the clinical value of prostate specific antigen velocity (PSAV) in predicting the extraprostatic extension of clinically localized prostate cancer. Methods: One hundred and three patients who underwent radical prostatectomy for clinically localized prostate cancer were included in the analysis. The correlation between preoperative parameters, including PSA-based parameters, clinical stage, and histological biopsy findings, and the pathological findings were analyzed. Logistic regression analysis was performed to identify a significant set of independent predictors for the local extent of the disease. Results: Sixty-four (60.2%) patients had organ confined prostate cancer and 39 (39.8%) patients had extraprostatic cancer. The biopsy Gleason score, PSA, PSA density, PSA density of the transition zone, and PSAV were significantly higher in the patients with extraprostatic cancer than in those with organ confined cancer. Multivariate logistic regression analysis indicated that the biopsy Gleason score, endorectal magnetic resonance imaging findings, and PSAV were significant predictors of extraprostatic cancer (P < 0.01). Probability curves for extraprostatic cancer were generated using these three preoperative parameters. Conclusions: The combination of PSAV, endorectal magnetic resonance imaging findings, and biopsy Gleason score can provide additional information for selecting appropriate candidates for radical prostatectomy.

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Papillary renal cell carcinoma

Kosaka Takeo, Mikami Shuji, Miyajima Akira, Kikuchi Eiji, Nakagawa Ken, Ohigashi Takashi, Nakashima Jun, Oya Mototsugu

Clinical and Experimental Nephrology 12 （ 3 ） 195 - 199 2008年06月

ISSN 1342-1751

Background: Two different subtypes of papillary renal cell carcinoma (PRCC) have so far been identified, type-1 with small cells and pale cytoplasm and type-2 with large cells and eosinophilic cytoplasm. It has generally been accepted that type-1 tumors have favorable features in comparison with type-2 tumors, suggesting that these subtypes could be different clinicopathological entities, and, as a result, that the subtypes need to be characterized. Forty cases of PRCCs were reviewed, with special attention to the distinct clinicopathological difference and the response to cytokine therapy. Methods: Thirty-five cases of PRCC diagnosed between January 1997 and August 2007 were reviewed. PRCCs were classified according to the criteria of Delahunt and Eble. Results: Of these 40 patients, 20 and 20 were diagnosed to be type-1 and type-2 PRCCs, respectively. No lymphatic or vascular invasion or distant metastasis were observed in patients with type-1 PRCC. The nuclear grade in all type-1 PRCCs was low grade. The nuclear grade (P ≤ 0.01) and the positive rate of vascular invasion (P ≤ 0.05) was significantly higher in type-2 than in type-1 PRCCs. Distant metastasis was detected preoperatively in three patients with type-2 PRCC. One patient with metastatic type-2 PRCCs demonstrated a response to IL-2 therapy. Conclusion: PRCCs include two distinct morphological types of tumor and type-2 PRCCs tends to have unfavorable features in comparison with type-1 PRCCs. These results support the clinical basis for the need to perform morphological subtyping of PRCCs when clinically evaluating such patients.

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Prediction of bone metastases by combination of tartrate-resistant acid phosphatase, alkaline phosphatase and prostate specific antigen in patients with prostate cancer

Ozu Choichiro, Nakashima Jun, Horiguchi Yutaka, Oya Mototsugu, Ohigashi Takashi, Murai Masaru

International Journal of Urology 15 （ 5 ） 419 - 422 2008年05月

ISSN 0919-8172

Objective: The clinical value of serum tartrate-resistant acid phosphatase (TRACP), prostate specific antigen (PSA), alkaline phosphatase (ALP), and prostatic acid phosphatase (PACP) for the prediction of bone metastases in prostate cancer were investigated. Methods: TRACP, PACP, ALP, and PSA serum levels were measured in 215 patients with prostate cancer, including 160 without and 55 with bone metastases. Correlation of serum marker levels with bone metastases was assessed using receiver operating characteristics (ROC) analysis. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated for each serum marker. Multivariate stepwise logistic regression analysis was used to identify independent predictors for the presence of bone metastasis. Results: Mean serum TRACP, PACP, ALP, and PSA levels were significantly elevated in patients with bone metastases compared with those without (P < 0.05). PSA and PACP levels increased significantly with clinical stage of the disease, whereas TRACP and ALP levels only increased significantly in stage D2. Serum TRACP levels correlated significantly with extent of disease on bone scans. ROC analyses showed no significant differences in area under the curve for these markers. Logistic regression analysis demonstrated that PSA, ALP, and TRACP were significant predictors of bone metastasis. Predicted and observed risks of bone metastasis were well correlated when TRACP, ALP, and PSA were combined and bone scan could have been omitted in 70% of patients by assessing these three markers. Conclusions: Serum TRACP can be considered a useful predictor of bone metastases in prostate cancer. A combination of TRACP, ALP, and PSA can obviate the need for a bone scan in 70% of cases.

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The predictors of local recurrence after radical cystectomy in patients with invasive bladder cancer

Ide Hiroki, Kikuchi Eiji, Miyajima Akira, Nakagawa Ken, Ohigashi Takashi, Nakashima Jun, Oya Mototsugu

Japanese Journal of Clinical Oncology 38 （ 5 ） 360 - 364 2008年05月

ISSN 0368-2811

Objectives: To examine the association between local recurrence and distant metastasis or disease-specific survival and identify independent factor predictors for local recurrence. Methods: We identified a study population of 146 consecutive patients treated surgically for invasive bladder cancer at our institution between 1987 and 2003. We clarified the relationship among local recurrence, distant metastasis and disease-specific survival and identified significant predictors for local recurrence. Results: Local recurrence developed in 26 (17.8%) of the 146 patients at a median of 10 months (range, 1-73 months) after cystectomy. It was independently associated with distant metastasis in addition to the number of retrieved lymph nodes. The 2- and 5-year metastasis-free rates were 86.7 and 76.5% in patients without local recurrence and 26.5 and 0% in those with local recurrence (P < 0.001), respectively. The presence or absence of local recurrence and tumor grade were independent predictors of disease-specific survival. The 2- and 5-year disease-specific survival rates were 93.5 and 88.3% in patients without local recurrence and 55.1 and 35.4% in those with local recurrence (P < 0.001). The presence of concomitant adenocarcinoma component, pathological nodal involvement and the number of retrieved lymph nodes were independent predictors of local recurrence. Conclusions: Local recurrence was independently associated with distant metastasis and disease-specific survival. Patients who have the predictive factors described above may benefit from integrated surgical therapies with post-operative adjuvant chemotherapy.

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Metastatic type-2 papillary renal cell carcinoma responded to interleukin-2 therapy

Kosaka Takeo, Mikami Shuji, Miyajima Akira, Oya Mototsugu

Clinical and Experimental Nephrology 12 （ 2 ） 155 - 158 2008年04月

ISSN 1342-1751

This report documents a case of metastatic papillary renal cell carcinoma (PRCC) which successfully responded to interleukin-2 (IL-2) therapy. A 59-year-old male presented with a left renal mass measuring 3.0 cm in diameter and a right adrenal mass measuring 5.0 cm in diameter. He underwent a left partial nephrectomy and a right adrenalectomy. The histological findings revealed pT1bN1M1 type-2 PRCC and metastatic renal cell carcinoma in the right adrenal gland. The patient was given interferon-α (IFN-α) after the operation for 3 months. A CT scan revealed a metastatic nodule measuring 6.0 cm in diameter near the surface of the liver at 4 months after the opereation. The patient was given interleukin-2 (IL-2), 7 × 10⁵ units/day intravenously, for 3 days per week. A CT scan revealed this hepatic nodule to have decreased in size from 6.0 to 4.0 cm after 4 months of IL-2 therapy. However, a new metastatic nodule measuring 6.0 cm in diameter was found which came in contact with the spleen. Next, the patient was given an increased dose of IL-2 from 7 × 10⁵ to 1.4 × 10⁶ units/day intravenously, for 3 days per week. At 9 months of follow-up after the dose escalation, a CT scan revealed a dramatic decrease in the size of these two metastatic nodules to 1.5 and 0.5 cm, respectively. This is a very rare case in that it represents a type-2 PRCC which dramatically responded to low-dose IL-2 therapy.

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RANKL expression in clear cell renal cell carcinomas and its association with bone metastasis and cancer cell migration

Mikami Shuji, Katsube Ken-Ichi, Oya Mototsugu, Mochizuki Satsuki, Shimoda Masayuki, Mizuno Ryuichi, Ishida Masaru, Ikeda Tohru, Mukai Makio, Okada Yasunori

JOURNAL OF UROLOGY 179 （ 4 ） 88 - 88 2008年04月

研究論文（学術雑誌）, 共著, ISSN 0022-5347

Simple stratification of survival using bone scan and serum C-reactive protein in prostate cancer patients with metastases

Nakashima Jun, Kikuchi Eiji, Miyajima Akira, Nakagawa Ken, Oya Mototsugu, Ohigashi Takashi, Murai Masaru

Urologia Internationalis 80 （ 2 ） 129 - 133 2008年03月

ISSN 0042-1138

Background: IL-6 has been reported to be a significant prognostic factor for prostate cancer and induces synthesis of C-reactive protein (CRP) by hepatocytes. The present study was undertaken to evaluate the clinical value of serum CRP in prostate cancer patients with metastases. Methods: The prognostic significance of serum CRP as well as tumor histology, extent of disease (EOD) on bone scan, serum levels of prostate-specific antigen (PSA) and alkaline phosphatase (ALP) and hemoglobin was assessed using Cox's proportional hazards model analyses in 126 prostate cancer patients with metastases treated with endocrine therapy. Results: Serum levels of CRP, PSA and ALP significantly increased and hemoglobin significantly decreased with advancing EOD grade. Univariate analysis demonstrated that EOD, CRP, PSA, ALP, hemoglobin and tumor histology are significantly associated with disease-specific survival. Multivariate analysis demonstrated that serum CRP and EOD were significant prognostic factors. The 5-year survival rates in low-risk patients (CRP ≤0.15 mg/dl and EOD ≤1) and high-risk patients (CRP >0.15 mg/dl and EOD ≥2) were 74 and 24%, respectively. Conclusion: These results indicate that a combination of serum CRP and EOD can identify patients with a poor prognosis who may be candidates for innovative treatments among prostate cancer patients with metastases.

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Right orbital metastasis from left renal cell carcinoma

Takeda Toshikazu, Yasumizu Yota, Hasegawa Masanori, Morita Shinya, Oya Mototsugu

Japanese Journal of Clinical Urology 62 （ 5 ） 319 - 321 2008年

ISSN 0385-2393

A 76-year-old woman receieved right thyroidectomy for a right thyroid tumor and the histopathological diagnosis was clear cell carcinoma. Radiological examination revealed left renal cell carcinoma with metastasis to the pancreas and left radical nephrectomy was performed. After the operation, IFN therapy was performed. But the tumor recurred at the same region in 2 years and metastasized to the lung in 3 years, to the right orbit in 6 years. Tumorectomy of the orbital tumor was performed and the histopathological diagnosis was suggestive of metastatic tumor from renal cell carcinoma.

腹部腫瘤を主訴とする後腹膜原発粘液嚢胞腺癌

伊藤祐二郎, 大家基嗣, 石田勝, 安藤利行, 橋口明典, 村井勝

臨床泌尿器科 62(1) 57 2008年

研究論文（学術雑誌）, 共著

The novel NF-kappa B activation inhibitor dehydroxymethyl-epoxyquinomicin suppresses anti-thy1.1-induced glomerulonephritis in rats

Kosaka Takeo, Miyajima Akira, Kikuchi Eiji, Horiguchi Yutaka, Umezawa Kazuo, Ohigashi Takashi, Nakashima Jun, Asano Tomohiko, Oya Mototsugu

NEPHRON EXPERIMENTAL NEPHROLOGY 110 （ 1 ） E17 - E24 2008年

研究論文（学術雑誌）, 共著, ISSN 1660-2129

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Development of testicular alpha-fetoprotein-secreting germ cell tumor 3 years after treatment of intracranial lesion identified as non-secreting germ cell tumor on the basis of clinical data - Case report

Takahashi Satoshi, Yoshida Kazunari, Mikami Shuji, Oya Mototsugu, Kawase Takeshi

Neurologia Medico-Chirurgica 48 （ 11 ） 522 - 525 2008年

ISSN 0470-8105

A 22-year-old Asian male developed testicular alpha-fetoprotein (AFP)-secreting germ cell tumor 3 years after treatment of a disseminated intracranial lesion identified as non-secreting germ cell tumor on the basis of clinical data. Magnetic resonance imaging showed a massive lesion with necrosis appearing as hypointense on T₁- and hyperintense on T ₂-weighted imaging, with heterogeneous enhancement. The blood AFP level was as high as 129 ng/ml (previously, as low as 5 ng/ml) and abdominal computed tomography showed para-aortic lymph node swelling. Left orchidectomy was performed and histological examination indicated the presence of AFP-secreting germ cell tumor despite severe necrosis of the tissue. Improved chemoradiotherapy for intracranial germ cell tumor will lead to long-term survival of most patients with germ cell tumor. Patients may subsequently develop germ cell tumors at other sites in the body. Therefore, follow up should monitor for tumor recurrence not only in the brain but also in other locations.

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A case of primary retroperitoneal cystadenocarcinoma

Ito Yujiro, Oya Mototsugu, Ishida Masaru, Ando Toshiyuki, Hashiguchi Akinori, Murai Masaru

Japanese Journal of Clinical Urology 62 （ 1 ） 57 - 59 2008年

ISSN 0385-2393

A 71-year-old woman was admitted to our hospital complaining of right lower abdominal mass. Computed tomography, and magnetic resonance imaging showed a cystic tumor, 14 cm in diameter, located at the right lower abdomen with cyst wall calcification. Immunohistochemical staining was positive for CA19-9, but not for CEA and CA125. A transabdominal tumorectomy was performed. The removed tumor was 17.7 x 14.4 x 11.2 cm in size, weighing 1,870 g, and hisotopathological retroperitoneal cystadenocarcinoma.

Clinical Implications of Tumor Size and Local Extent of Primary Prostatic Lesions in Prostate Cancer Patients with Metastases

Nakashima Jun, Tanimoto Akihiro, Kikuchi Eiji, Miyajima Akira, Nakagawa Ken, Oya Mototsugu, Ohigashi Takashi, Murai Masaru

Urology 70 （ 1 ） 86 - 90 2007年07月

ISSN 0090-4295

Objectives: To investigate the clinical significance of local assessment by endorectal magnetic resonance imaging (MRI) in prostate cancer patients with metastases. Methods: The local extent and tumor size were determined by endorectal MRI in 95 prostate cancer patients with metastases, and their clinical implications were assessed. Results: The maximum diameter and tumor volume significantly correlated with the local extent of disease but not with extent of disease (EOD) on bone scan. In univariate analyses, EOD, serum prostate-specific antigen level, serum alkaline phosphatase level, and hemoglobin level were significantly associated with disease-specific survival, whereas tumor size and local extent of primary lesions were not. In a multivariate analysis EOD on bone scan was a significant prognostic factor. Conclusions: Tumor size and local extent of the primary lesion estimated by endorectal MRI were not associated with disease-specific survival. Assessment of the primary lesion by endorectal MRI is of limited value in predicting the prognosis of prostate cancer patients with metastases.

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Prevalence of renal cell carcinoma

Marumo Ken, Kanayama Hiroomi, Miyao Noriomi, Nakazawa Hayakazu, Ozono Seiichiro, Horie Shigeo, Nagamori Satoshi, Igarashi Tatsuo, Hasegawa Michihiko, Kimura Go, Nakao Masahiro, Nakamoto Takahisa, Naito Seiji, Tsushima Tomoyasu, Onishi Tetsuro, Fukuda Momokuni, Shinohara Nobuo, Eto Masatoshi, Kobayashi Mikio, Senga Yutaka, Tomita Yoshihiko, Terachi Toshiro, Tokuda Noriaki, Nonomura Norio, Hayakawa Masamichi, Matsuzaki Osamu, Nagashima Yoji, Fujii Yasuhisa, Wada Yoshihiro, Mizutani Yoichi, Oya Mototsugu

International Journal of Urology 14 （ 6 ） 479 - 482 2007年06月

ISSN 0919-8172

Objective: To investigate the incidence of renal cell carcinoma, classified by sex, age group and region in Japan, following a 5-year interval after a previous survey performed in 1997. Methods: The survey was conducted between the beginning of January 2002 and the end of December 2002. A total of 1288 institutions in all 47 prefectures throughout Japan were requested to register cases. Results: There were 7405 persons with renal cell carcinoma, consisting of 5063 males and 2342 females. Crude incidence rates were 8.2 and 3.6 per 100 000 population for men and women, respectively. Incidence rates in the Hokkaido region were highest followed by the Shikoku region. Conclusions: Despite incidence of renal cell carcinoma increasing to 7405 from the 6358 persons in 1997, statistical data reported by the Ministry of Health, Labor and Welfare indicate that rising age-adjusted death rate for this tumor reached a ceiling in the past decade. Early detection may have contributed to this current trend; however, further epidemiological research is required to fully elucidate this.

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Renal cancer cells lacking hypoxia inducible factor (HIF)-1α expression maintain vascular endothelial growth factor expression through HIF-2α

Shinojima Toshiaki, Oya Mototsugu, Takayanagi Atsushi, Mizuno Ryuichi, Shimizu Nobuyoshi, Murai Masaru

Carcinogenesis 28 （ 3 ） 529 - 536 2007年03月

ISSN 0143-3334

Recent efforts have been aimed at targeting the hypoxia inducible factor (HIF)-mediated hypoxia-induced gene pathway for renal cell carcinomas (RCC) therapy. Among the various genes induced by HIF, vascular endothelial growth factor (VEGF) is one of the critical mediators in angiogenesis, tumor growth and metastasis. To date, however, limited information is available on the functional differences regarding VEGF transcription between the HIF subunits, namely HIF-1α and HIF-2α. To investigate the HIF-1α and HIF-2α-dependent effect on VEGF gene induction in RCC, a panel of human RCC cell lines was analyzed. We found that a loss of HIF-1α protein expression was a common event in RCC cell lines, which was associated not only with truncated HIF-1α mRNA transcripts but also with transcriptional silencing. Since the CpG rich promoter region of the HIF-1α gene contained a similar frequency of methylated CpG dinucleotides in RCC cell lines, a complex and non-uniform mechanism may be involved in this phenomenon. In these HIF-1α defective cell lines, the knockdown of the HIF-2α gene demonstrated that HIF-2α regulated the VEGF production, irrespective of the VHL gene mutation status. In contrast, HIF-1α played a predominant role in VEGF secretion in the cells expressing both wild-type HIF-1α and HIF-2α proteins. HIF-1α may therefore represent an important target molecule for RCC therapy; however, HIF-2α should be targeted in HIF-1α defective renal cancer cells.

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Interleukin 6 Is Associated with Cachexia in Patients with Prostate Cancer

Kuroda Kenji, Nakashima Jun, Kanao Kent, Kikuchi Eiji, Miyajima Akira, Horiguchi Yutaka, Nakagawa Ken, Oya Mototsugu, Ohigashi Takashi, Murai Masaru

Urology 69 （ 1 ） 113 - 117 2007年01月

ISSN 0090-4295

Objectives: To evaluate the relationship between serum interleukin (IL)-6 and cachexia in patients with prostate cancer. Methods: Serum levels of IL-6, total protein, albumin, total cholesterol, and hemoglobin concentration were determined in 164 blood samples from patients with prostate cancer. The body mass index and performance status were also determined. Results: The serum total protein, albumin, and cholesterol levels, hemoglobin levels, and body mass index of the patients whose serum IL-6 level was 7 pg/mL or greater were significantly lower (P <0.05) than the corresponding values in patients with a serum IL-6 level of less than 7 pg/mL. The serum IL-6 level of patients with a serum albumin level of less than 3.5 g/dL, serum total protein level of less than 7.0 g/dL, serum total cholesterol level of less than 180 mg/dL, hemoglobin level of less than 11.0 g/dL, and body mass index of less than 21 kg/m² were significantly greater (P <0.05) than the values in their respective counterparts. A significant correlation was found between the elevation of serum IL-6 and performance status (P <0.05). The mortality rate of patients with greater serum IL-6 levels was significantly greater than that of those with lower serum IL-6 levels in patients with untreated disease, patients in remission, and patients with relapse (all P <0.05). Conclusions: These findings suggest that IL-6 may be one of the factors contributing to the complex syndrome of cachexia in patients with prostate cancer (all P <0.05).

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Preoperative Nomograms for Predicting Stone-Free Rate After Extracorporeal Shock Wave Lithotripsy

Kanao Kent, Nakashima Jun, Nakagawa Ken, Asakura Hirotaka, Miyajima Akira, Oya Mototsugu, Ohigashi Takashi, Murai Masaru

Journal of Urology 176 （ 4 ） 1453 - 1457 2006年10月

ISSN 0022-5347

Purpose: Extracorporeal shock wave lithotripsy is currently accepted as a first line treatment modality for urolithiasis. In obtaining informed consent it is important to inform patients of the stone-free rate with extracorporeal shock wave lithotripsy before surgery. The present study was performed to develop preoperative nomograms for predicting stone-free rates after extracorporeal shock wave lithotripsy. Materials and Methods: A total of 435 patients with 507 urinary stones were treated with extracorporeal shock wave lithotripsy with a Dornier Lithotripter D. Patient age, sex, body mass index, number of stone(s) in each treatment, stone length, side and location were evaluated before extracorporeal shock wave lithotripsy, and treatment efficacies were evaluated at 3 months after each session. The treated stones were divided into 2 groups, those in cases that were stone-free with a single extracorporeal shock wave lithotripsy session and those in all other cases. Multivariate analysis was performed using a logistic regression model. The nomograms were developed by repeating the analysis on 200 bootstrap samples. Results: Stone length, location and number were identified as significant variables on multivariate analysis, and a logistic regression model was developed using these variables. The nomograms predicting stone-free rate at 3 months after single extracorporeal shock wave lithotripsy treatment were finally developed from 200 bootstrap samples. In these nomograms the stone-free probability was highest for solitary proximal ureteral stones less than 5 mm in size (93.8%) and lowest for multiple caliceal stones greater than 21 mm (10.5%). Conclusions: This study demonstrated that stone size, location and number are significant predictors of extracorporeal shock wave lithotripsy outcome. We have developed nomograms for predicting the stone-free rate of extracorporeal shock wave lithotripsy, which is useful for counseling patients with urolithiasis before surgery.

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