慶應義塾研究者情報データベース

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• Optimal surgical treatment for paratesticular leiomyosarcoma: retrospective analysis of 217 reported cases

  Kamitani R., Matsumoto K., Takeda T., Mizuno R., Oya M.

  BMC Cancer （BMC Cancer)  22 （ 1 ）  2022年12月

  　概要を見る

  Background: Paratesticular leiomyosarcoma (LMS) is a rare tumor. Conventionally, tumor resection by high inguinal orchiectomy is performed as the preferred treatment approach for paratesticular sarcoma. On the other hand, testis-sparing surgery has recently attracted attention as a less-invasive treatment option for paratesticular sarcoma. However, the prognostic predictors and optimal treatment strategy for paratesticular LMS remain unclear because of its rarity. In this study, we systematically reviewed previously reported cases of paratesticular LMS to evaluate the prognostic factors and establish the optimal treatment strategy. Methods: A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular LMS published between 1971 and 2020 in English. The final cohort included 217 patients in 167 articles. The starting point of this study was the time of definitive surgical treatment, and the end point was the time of local recurrence (LR), distant metastasis (DM), and disease-specific mortality. Results: Patients with cutaneous LMS had a slightly better LR-free survival, DM-free survival, and disease-specific survival than those with subcutaneous LMS (p = 0.745, p = 0.033, and p = 0.126, respectively). Patients with higher grade tumors had a significantly higher risk of DM and disease-specific mortality (Grade 3 vs Grade 1 p < 0.001, and Grade 3 vs Grade 1 p < 0.001, respectively). In addition, those with a microscopic positive margin had a significantly higher risk of LR and DM than those with a negative margin (p < 0.001, and p = 0.018, respectively). Patients who underwent simple tumorectomy had a slightly higher risk of LR than those who underwent high inguinal orchiectomy (p = 0.067). Subgroup analysis of cutaneous LMS demonstrated that the difference in LR between simple tumorectomy and high inguinal orchiectomy was limited (p = 0.212). On the other hand, subgroup analysis of subcutaneous LMS revealed a significant difference in LR (p = 0.039). Conclusions: Our study demonstrated that subcutaneous LMS and high-grade tumors are prognostic factors for paratesticular LMS. For subcutaneous LMS, tumorectomy with high inguinal orchiectomy should be the optimal treatment strategy to achieve a negative surgical margin.

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• Evaluation of Gleason Grade Group 5 in a Contemporary Prostate Cancer Grading System and Literature Review

  Kamitani R., Matsumoto K., Kosaka T., Takeda T., Hashiguchi A., Tanaka N., Morita S., Mizuno R., Shinojima T., Asanuma H., Oya M.

  Clinical Genitourinary Cancer （Clinical Genitourinary Cancer)  19 （ 1 ） 69 - 75.e5 2021年02月

  ISSN  15587673

  　概要を見る

  The aim of this study was to validate the contemporary grading system. Our follow-up study revealed that men with Gleason score (GS) 4+5 and those with Gleason grade group 4 had a similar prognosis. However, there was a significant discrepancy in prognosis between GS 4+5 and GS 5+4 or higher. Gleason grade groups 4 and 5 in the contemporary grading system should be reviewed.

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• Optimal treatment strategy for paratesticular liposarcoma: retrospective analysis of 265 reported cases

  Kamitani R., Matsumoto K., Takeda T., Mizuno R., Oya M.

  International Journal of Clinical Oncology （International Journal of Clinical Oncology)  25 （ 12 ） 2099 - 2106 2020年12月

  ISSN  13419625

  　概要を見る

  Background: Liposarcoma is one of the most common subtypes of soft tissue sarcoma. Although the standard treatment for localized liposarcoma is surgical resection with negative margins, a treatment specific to paratesticular liposarcoma has yet to be quantitatively evaluated. Methods: A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular liposarcoma published between 1979 and 2018 in English. The final cohort included 265 patients in 183 articles. The starting point was the time of surgical treatment, and the endpoint was the time of recurrence, including local recurrence, or distant metastasis. Results: The median patient age was 62 years and the median tumor size was 9.5 cm. In total, 178 patients underwent high inguinal orchiectomy and 40 underwent simple tumorectomy. Based on the Kaplan–Meier curves, recurrence-free survival rates were significantly higher for those who underwent high inguinal orchiectomy than for those who underwent tumorectomy. Moreover, those with microscopic positive margins had a higher risk of recurrence than those with negative margins, but adjuvant radiation therapy after resection had no statistically significant effect on recurrence-free survival, even in subgroup analysis of patients with positive margins. Regarding the pathological subtypes, dedifferentiated, pleomorphic, and round-cell liposarcoma had a higher risk of recurrence than well-differentiated or myxoid liposarcoma. In the multivariate analysis, high inguinal orchiectomy greatly affected recurrence-free survival. The tumor size and histological subtype were independent risk factors for recurrence. Conclusion: Complete resection with high inguinal orchiectomy is the optimal treatment for paratesticular liposarcoma.

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• Spontaneous rupture of renal cell carcinoma with sudden death due to myocardiac metastases: A case report

  Kamitani R., Ishida M., Kaneko Y., Kobayashi H., Miyazaki Y., Kosugi M.

  Japanese Journal of Clinical Urology （Japanese Journal of Clinical Urology)  73 （ 5 ） 320 - 323 2019年

  ISSN  03852393

  　概要を見る

  Cardiac metastasis in the absence of inferior vena cava (IVC) extension is extremely rare. We report a case of myocardiac metastasis from renal cell carcinoma (RCC) without IVC involvement. An 81-year-old female with left flank pain was referred to own clinic and CT revealed left huge renal mass with an extension to left renal vein, descending colon involvement, and multiple lymph node and lung metastases. The following day, she was brought to the emergency room in a state of shock with severe abdominal pain. CT showed spontaneous rupture of RCC. We performed transcatheter arterial embolization and left transabdominal nephrectomy with partial descending colectomy. After the operation CT and echocardiography revealed cardiac metastasis. Postoperative course was uneventful, however, she suddenly died 39 days after the operation. Autopsy revealed myocardiac metastases of RCC, and blockade of the conducting system of the heart was considered to have caused the severe arrhythmia and sudden cardiac arrest.