研究者詳細 - 田中　伸之

論文 - 田中　伸之

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Risk factors for postoperative fever after laparoscopic adrenalectomy focusing on hormones produced: a case control study.

Izawa M, Takeda T, Anno T, Iwasawa T, Yasumizu Y, Tanaka N, Matsumoto K, Morita S, Kosaka T, Mizuno R, Asanuma H, Oya M

BMC urology 24 （ 1 ） 90 2024年04月

Background: Laparoscopic adrenalectomy is widely performed for a number of hormone-producing tumors and postoperative management depends on the hormones produced. In the present study, we conducted a retrospective analysis to clarify the risk factors for postoperative complications, particularly postoperative fever after laparoscopic adrenalectomy. Methods: We analyzed 406 patients who underwent laparoscopic adrenalectomy at our hospital between 2003 and 2019. Postoperative fever was defined as a fever of 38 °C or higher within 72 h after surgery. We investigated the risk factors for postoperative fever after laparoscopic adrenalectomy. Results: There were 188 males (46%) and 218 females (54%) with a median age of 52 years. Among these patients, tumor pathologies included 188 primary aldosteronism (46%), 75 Cushing syndrome (18%), and 80 pheochromocytoma (20%). Postoperative fever developed in 124 of all patients (31%), 30% of those with primary aldosteronism, 53% of those with pheochromocytoma, and 8% of those with Cushing syndrome. A multivariate logistic regression analysis identified pheochromocytoma and non-Cushing syndrome as independent predictors of postoperative fever. Postoperative fever was observed in 42 out of 80 cases of pheochromocytoma (53%), which was significantly higher than in cases of non-pheochromocytoma (82/326, 25%, p < 0.01). In contrast, postoperative fever developed in 6 out of 75 cases of Cushing syndrome (8%), which was significantly lower than in cases of non-Cushing syndrome (118/331, 35.6%, p < 0.01). Conclusion: Since postoperative fever after laparoscopic adrenalectomy is markedly affected by the hormone produced by pheochromocytoma and Cushing syndrome, it is important to carefully consider the need for treatment.

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Genomic profiling and clinical utility of circulating tumor DNA in metastatic prostate cancer: SCRUM-Japan MONSTAR SCREEN project.

Shiota M, Matsubara N, Kato T, Eto M, Osawa T, Abe T, Shinohara N, Nishimoto K, Yasumizu Y, Tanaka N, Oya M, Fujisawa T, Horasawa S, Nakamura Y, Yoshino T, Nonomura N

BJC reports 2 （ 1 ） 28 2024年04月

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Impact of prostatic shape on the difficulty of robot-assisted laparoscopic radical prostatectomy.

Kamisawa K, Matsumoto K, Takeda T, Takamatsu K, Niwa N, Yasumizu Y, Tanaka N, Morita S, Kosaka T, Mizuno R, Asanuma H, Oya M

Asian journal of endoscopic surgery （Asian Journal of Endoscopic Surgery） 17 （ 2 ） e13291 2024年04月

ISSN 1758-5902

Introduction: To investigate the impact of prostatic shape observed on preoperative magnetic resonance imaging (MRI) on the difficulty of robot-assisted laparoscopic radical prostatectomy (RALP). Methods: We retrospectively reviewed the operative records of 211 patients who underwent RALP. We excluded patients who received neoadjuvant therapy. All surgeries in this study were performed by two surgeons. Each patient clinicopathological and surgical data were reviewed. Prostate sphericity was evaluated by measuring the roundness of the prostate at the largest axial slice by MRI. The console time was adopted as an objective indicator for assessing surgical difficulty. Results: The mean prostate volume was 34 cc (range 14–88) and the mean prostate roundness was 0.55 (range 0.24–0.90). The mean console time was 194 min (range 95–296). To assess the relationship between prostate volume and console time, scatter plot analysis was performed. The prostate volume had a weak positive correlation with the console time (r =.165, p =.016). Similarly, scatter plot analysis between the prostate roundness and console time demonstrated a weak positive correlation (r =.167, p =.015). Next, we performed subgroup analysis of 56 patients with a large prostate volume (≥40 cc), and the positive correlation between the prostate volume and the console time disappeared (r =.142, p =.296). On the other hand, the prostate roundness was more strongly correlated with the console time (r =.439, p =.001). Conclusions: The spherical shape of the prostate is associated with the surgical difficulty of RALP, especially in patients with a large prostate volume.

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【薬の使い方がすぐわかる　泌尿器科処方ガイド】腫瘍　抗がん薬の副作用対策　急性過敏性反応

水野隆一, 田中伸之, 大家基嗣

臨床泌尿器科（(株)医学書院） 78 （ 4 ） 208 - 211 2024年04月

ISSN 0385-2393

Profiling Fibroblast Growth Factor Receptor 3 Expression Based on the Immune Microenvironment in Upper Tract Urothelial Carcinoma.

Shigeta K, Matsumoto K, Kitaoka S, Omura M, Umeda K, Arita Y, Mikami S, Fukumoto K, Yasumizu Y, Tanaka N, Takeda T, Morita S, Kosaka T, Mizuno R, Hara S, Oya M

European urology oncology 7 （ 6 ） 1338 - 1349 2024年02月

BACKGROUND: Although several studies have shown favorable outcomes in upper tract urothelial carcinoma (UTUC) with fibroblast growth factor receptor 3 (FGFR3) mutations and/or expression, the relationship between immune cell markers and FGFR3 expression remains unknown. OBJECTIVE: To clarify the FGFR3-based immune microenvironment and investigate biomarkers to predict the treatment response to pembrolizumab (Pem) in patients with UTUC. DESIGN, SETTING, AND PARTICIPANTS: We conducted immunohistochemical staining in 214 patients with UTUC. The expression levels of FGFR3, CD4, CD8, CD68, CD163, CD204, and programmed cell death ligand 1 (PD-L1) were examined. INTERVENTION: All UTUC patients underwent radical nephroureterectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed the relationship between these immune markers and patient prognosis. RESULTS AND LIMITATIONS: A total of 109 (50.9%) patients showed high FGFR3 expressions and a favorable prognosis compared with the remaining patients. Among the six immune markers, CD8 high expression was an independent favorable factor, whereas CD204 expression was an independent prognostic factor for cancer death. From the FGFR3-based immune clustering, three immune clusters were identified. Cluster A showed low FGFR3 with tumor-associated macrophage-rich components (CD204+) followed by a poor prognosis due to a poor response to Pem. Cluster B showed low FGFR3 with an immune hot component (CD8+), followed by the most favorable prognosis owing to a good response to Pem. Cluster C showed high FGFR3 expression but an immune cold component, followed by a favorable prognosis due to the high FGFR3 expression, but a poor response was confirmed with Pem. CONCLUSIONS: Although most patients exhibit a poor response to Pem, individuals with low FGFR3 expression and immune hot status may benefit clinically from Pem treatment. PATIENT SUMMARY: We conducted immunohistochemical staining to evaluate fibroblast growth factor receptor 3 (FGFR3)-related immune microenvironment by evaluating the expressions of CD4, CD8, CD68, CD163, CD204, and PD-L1 in 214 upper tract urothelial carcinoma patients. We identified three distinct immune clusters based on FGFR3 expressions and found that patients with a low FGFR3 expression but immune hot status received the maximum benefit from an immune checkpoint inhibitor.

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Anemia in patients ≥ 75 years with metastatic clear cell renal cell carcinoma: an important poor prognostic factor in the international metastatic renal cell carcinoma database consortium model.

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

BMC urology （BMC Urology） 24 （ 1 ） 13 2024年01月

Background: Due to an increase in life expectancy, the incidence of metastatic renal cell carcinoma (mRCC) in patients aged ≥75 years has been increasing. In this study we investigated the characteristics before treatment and the outcomes of systemic therapies for patients aged ≥75 years with mRCC and compared the results with those for patients aged < 75 years in order to determine whether differences in age influenced survival. Methods: A total of 206 consecutive Japanese patients with mRCC, including 47 patients aged ≥75 years, who received systemic therapy were included. Clinical data from medical records were retrieved and analyzed retrospectively. Survival analyses were determined using a Kaplan–Meier method, and analyzed with a log-rank test. Results: Elderly patients categorized as favorable risk group based on the International Metastatic RCC Database Consortium (IMDC) stratification system were significantly lower. Among IMDC risk factors, the rate of anemia was significantly higher in elderly patients. No statistically significant benefit in progression free survival for first and second line treatment was observed, whereas improvements in overall survival as well as cancer specific survival were seen in patients aged < 75 years. Conclusions: For mRCC patients aged ≥75 years, a higher proportion of base line anemia, which resulted in higher rates of IMDC intermediate/poor risk, would be responsible for shorter OS/CSS. Furthermore, mRCC patients aged ≥75 years tend to receive BSC instead of second line active treatment. Overcoming under-treatment in elderly patients might help to prolong survival in mRCC.

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尿管狭窄に対して口腔粘膜を用いた拡大onlay法尿管形成術を施行した1例

岩佐俊, 浅沼宏, 高橋遼平, 福本桂資郎, 安水洋太, 田中伸之, 武田利和, 松本一宏, 森田伸也, 小坂威雄, 水野隆一, 大家基嗣

日本泌尿器科学会雑誌（(一社)日本泌尿器科学会） 115 （ 1 ） 37 - 41 2024年01月

ISSN 0021-5287

症例は14歳男子.12歳時に水腎症と腎機能の増悪を認め,近医で膀胱腫瘍,左尿管腫瘍の診断となった.前医で経尿道的膀胱腫瘍切除術,尿管腫瘍生検が施行され,線維上皮性ポリープの診断となった.尿管ポリープに対して経尿道的切除を試みられたが尿道狭窄を併発したため到達困難となり,左腎瘻造設,経皮的レーザー焼灼術が施行された.術後4ヵ月,尿管狭窄もきたし,尿路再建の目的に当院へ紹介となった.尿道狭窄に対して13歳時に包皮利用Palminteri法尿道形成術を施行した.逆行性腎盂造影,腎瘻造影検査で脊椎L4レベルに2cmの尿管狭窄,尿管鏡検査で脊椎L5レベルに残存ポリープを認めた.14歳時に尿管再建術を行った.端々吻合では吻合部の緊張が強いと考えられ,口腔粘膜利用拡大onlay法尿管形成術を行う方針とした.完全閉塞部と残存ポリープ部のみを最小限切除し,緊張のかからない尿管壁同士を一部端々吻合した.吻合部の対側の尿管壁は健常部まで十分にspatulateし,尿管ステントを留置後に15×40mm大の頬粘膜を縫着,頬粘膜のグラフト床として腹腔内から遊離した大網を吻合部に全周性に縫着した.術後13日で腎瘻を抜去,術後4ヵ月で尿管ステントを抜去した.術後1年および2年の逆行性腎盂造影,尿管鏡検査で再狭窄やポリープの再発は認めず,術後3年現在,左側腹部痛,腎盂腎炎,腎盂拡張などを認めず経過良好である.(著者抄録)

下大静脈後尿管を合併した膀胱尿管逆流に対して逆流防止術を施行した2例の比較

岩佐俊, 浅沼宏, 高橋遼平, 安水洋太, 田中伸之, 武田利和, 松本一宏, 森田伸也, 小坂威雄, 水野隆一, 大家基嗣

日本逆流性腎症フォーラム記録集（日本逆流性腎症フォーラム） 30回 19 - 21 2024年01月

ISSN 2435-323X

症例1(26歳女性)。11歳時に右膀胱尿管逆流(VUR)に対しCohen法による逆流防止術が施行された。今回、右水腎症を契機に下大静脈後尿管(RCU)の合併が明らかになり、右尿管尿管吻合術を行った結果、術後4年半経過現在、水腎症は改善している。尚、本症例は逆流防止術前にRCUの診断がされておらず、尿管の対側への牽引がRCUによる腎盂尿管移行部通過障害を悪化させた可能性が考えられた。症例2(19歳女性)。反復する発熱、右水腎症を主訴とした。超音波検査、CT検査、排尿時膀胱尿道造影の所見を踏まえて、RCU合併の右VURと診断された。尿管の牽引を伴わないLich-Gregoir法による逆流防止術を施行した結果、術後は水腎症の増悪なく、良好である。

Concomitant Prostate Needle Biopsy and Laser Vaporization of the Prostate Could Be a Risk of Postoperative Hemoglobin Decline, a Retrospective Study.

Ezaki T, Hongo H, Takamatsu K, Tanaka N, Oya M

Research and reports in urology （Research and Reports in Urology） 16 123 - 129 2024年

ISSN 2253-2447

Purpose: Contact laser vaporization of the prostate (CVP) for benign prostatic hyperplasia is a widely accepted and safe procedure for elderly patients because of its lower bleeding risks. However, CVP lacks a postoperative pathological examination for prostate cancer. Concomitant prostate biopsy and CVP may complement this disadvantage; however, the risk of bleeding associated with this procedure remains unclear. This study aimed to evaluate the safety of a concomitant prostate biopsy and CVP. Patients and Methods: This retrospective study included 106 men who had undergone CVP in Nerima General Hospital. Prostate biopsies and CVP were performed simultaneously on 16 patients. We defined the “hemorrhage group” by a >5% decrease in hemoglobin the day after surgery. Preoperative and operative indices were evaluated based on the association with the hemorrhage group. Results: Participants in the concomitant biopsy group were older (p = 0.001), had larger prostates (p = 0.014), a lower rate of prostate biopsy history (p = 0.046), longer postoperative urinary catheter duration (p = 0.024), and a higher rate of decline in hemoglobin levels the day after surgery (p = 0.023). Patients in the hemorrhage group (n = 20, 18.9%) showed a significantly higher rate of concomitant biopsy and CVP (p = 0.006). Multivariate analysis showed that concomitant prostate biopsy (p = 0.009, odds ratio = 4.61) was the sole statistically significant predictive factor for hemorrhage. Conclusion: Concomitant prostate biopsy and CVP of the prostate may increase the risk of bleeding.

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Appropriate definition of non-metastatic castration-resistant prostate cancer (nmCRPC) and optimal timing of androgen receptor signaling inhibitor (ARSI)

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

International Journal of Clinical Oncology （International Journal of Clinical Oncology） 29 （ 8 ） 1198 - 1203 2024年

ISSN 13419625

Background: Defined by rising PSA levels under androgen deprivation therapy (ADT) despite no visible metastases on conventional imaging, non-metastatic castration-resistant prostate cancer (nmCRPC) represents a complex clinical challenge. A significant subset of these patients rapidly develops metastatic disease, negatively impacting survival. We examined the difference in prognosis of nmCRPC patients according to the timing of therapeutic interventions with androgen receptor signaling inhibitor (ARSI). Methods: We examined 102 nmCRPC patients treated with ARSI. We divided patients according to their PSA levels when ARSI was administered: Cohort A (PSA 0.5–2.0 ng/mL), Cohort B (PSA 2.0–4.0 ng/mL), and Cohort C (PSA > 4.0 ng/mL). Utilizing the Kaplan–Meier method for survival analysis, our analytical starting point was the moment when PSA levels exceeded 0.5 ng/mL post-ADT nadir, ensuring a fair comparison and minimizing lead-time bias. Results: After excluding 5 patients whose PSA nadir after ADT > 0.5 ng/mL, patient distribution across Cohort A, Cohort B, and Cohort C was 32, 24, and 41 patients, respectively. Kaplan–Meier survival analysis highlighted a 2-year metastasis-free survival rate of 97% for Cohort A, 87% for Cohort B, and 73% for Cohort C. A marked statistical difference emerged when comparing Cohort A with Cohorts B and C, with a p-value of 0.043. Conclusion: The timely initiation of ARSI is paramount in nmCRPC management. Our findings strongly advocate for consideration of ARSI administration in nmCRPC patients before their PSA levels exceed 2.0 ng/mL. Our results indicated a PSA threshold of 1.0 ng/mL for nmCRPC definition which is more reasonable to administer ARSI without delay.

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AUGMENTED ONLAY BUCCAL MUCOSAL GRAFT URETEROPLASTY FOR URETERAL STRICTURE: A CASE REPORT

Iwasa S., Asanuma H., Takahashi R., Fukumoto K., Yasumizu Y., Tanaka N., Takeda T., Matsumoto K., Morita S., Kosaka T., Mizuno R., Oya M.

Japanese Journal of Urology 115 （ 1 ） 37 - 41 2024年

ISSN 00215287

A 14-year-old boy developed hydronephrosis and worsening renal function due to fibroepithelial polyps of the bladder and left ureter at the age of 12 years. The endoscopic treatment of ureteral polyps was attempted by his previous doctor; however urethral stricture and ureteral stricture developed and was untreatable. Therefore, he was referred to our hospital for further reconstructive treatment. He underwent Palminteri urethroplasty with penile skin graft for urethral stricture at the age of 13 years, followed by ureteroplasty at the age of 14 years. The stenotic ureter was minimally resected, with only complete obstruction and residual polyps, and augmented onlay ureteroplasty with a buccal mucosa graft was performed. Nephrostomy was removed 13 days after surgery, followed by the ureteral stent 4 months after surgery. Retrograde pyelography and ureteroscopy were performed 1 year and 2 years postoperatively, and neither recurrent strictures nor polyps were observed. The patient is doing well 3 years postoperatively.

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進行性尿路上皮癌に対するペムブロリズマブ投与中に副腎皮質刺激ホルモン単独欠損症をきたした血液透析患者の1例

北岡壮太郎, 水野隆一, 吉田理, 高橋遼平, 安水洋太, 田中伸之, 森田伸也, 大家基嗣

泌尿器外科（医学図書出版(株)） 36 （ 11 ） 1258 - 1261 2023年11月

ISSN 0914-6180

症例は79歳女性。右腎盂癌(pT1N0M0)にて右腎尿管全摘除術を施行後の約1年後に血液透析導入となった。術後2年で多発肺転移にて再発し,救援化学療法を2コース施行するもPDであったため,2次化学療法としてペムブロリズマブを開始した。6コース投与後に持続する発熱,倦怠感,脱力,意識障害にて当院に入院し,ACTH単独欠損症の診断となりirAEと考えられた。維持透析下でヒドロコルチゾンを補充し症状は改善,そのままペムブロリズマブを投与再開し,9ヵ月間PRを維持できた。(著者抄録)

【前立腺肥大症:近年の治療の進歩】接触式レーザー蒸散術(Contact laser Vaporization of the Prostate:CVP)の現状と展望

田中伸之, 大家基嗣

Prostate Journal （医学図書出版(株)） 10 （ 2 ） 145 - 150 2023年10月

ISSN 2188-4978

前立腺肥大症への接触レーザー蒸散術(CVP)は,光ファイバーを通して980nmダイオードレーザーを照射し,肥大した前立腺組織を気化させる。本邦では人口の高齢化に伴い,抗血栓療法を受ける患者数は増加傾向にある。ダイオードレーザーの有する蒸散力・止血能によって,抗血栓療法の休薬が難しい症例でも,安全な手術が可能となった。われわれは,抗血栓療法下のCVP安全性と有効性を評価した前向き観察研究を中心に,CVP治療の現状と展望について述べる。(著者抄録)

Prognostic impact of tumor ureteral invasion on recurrence after radical cystectomy.

Saito T, Matsumoto K, Tanaka N, Fukumoto K, Yasumizu Y, Takeda T, Morita S, Kosaka T, Mizuno R, Asanuma H, Hara S, Oya M

International urology and nephrology （International Urology and Nephrology） 56 （ 1 ） 129 - 135 2023年09月

ISSN 0301-1623

Purpose: Several preoperative factors have been suggested to be risk factors of disease recurrence after radical cystectomy. There is no study focusing on the impact on prognosis of bladder tumor ureteral invasion in preoperative imaging. Methods: The study population consisted of 136 patients, all of whom underwent radical cystectomy during the period between 2007–2019. We excluded patients with concurrent or a history of upper tract urothelial carcinoma and who underwent radical cystectomy for other cancers or nononcologic reasons. The starting point of this study was the timing of neoadjuvant chemotherapy or radical cystectomy and the endpoint was the timing of disease recurrence. To identify the factors influencing recurrence, univariate and multivariate analyses were performed using the Cox proportional hazard model. Recurrence-free survival curves were constructed using the Kaplan–Meier method. Results: Ureteral invasion was observed in 20 (14.7%) patients. Disease recurrence was observed in 11 (55.0%) of 20 ureteral invasion positive patients and 35 (30.2%) of 116 ureteral invasion negative patients, respectively. In the ureteral invasion positive group, clinical T and N stage were higher and hydronephrosis were more common than in the ureteral invasion negative group. According to the multivariate analysis, ureteral invasion (hazard ratio: 2.307, p = 0.016) and clinical N stage ≥ 1 (hazard ratio: 2.140, p = 0.028) were independent risk factors for postoperative recurrence. In the ureteral invasion positive group, more local recurrences were observed. Conclusion: This study suggested that ureteral invasion in preoperative imaging is a significant risk factor for postoperative recurrence.

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ASO Visual Abstract: Long-Term Prognosis and Treatment Strategy of Persistent PSA After Radical Prostatectomy.

Komori T, Matsumoto K, Kosaka T, Takeda T, Kamitani R, Yasumizu Y, Tanaka N, Morita S, Mizuno R, Asanuma H, Oya M

Annals of surgical oncology （Annals of surgical oncology） 30 （ 11 ） 6945 2023年07月

ISSN 1068-9265

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Factors affecting the selection of eligible candidates for focal therapy for prostate cancer

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

World Journal of Urology （World Journal of Urology） 41 （ 7 ） 1821 - 1827 2023年07月

ISSN 07244983

Purpose: Focal therapy (FT) is a treatment modality for prostate cancer that aims to reduce side effects. However, it remains difficult to select eligible candidates. We herein examined eligibility factors for hemi-ablative FT for prostate cancer. Methods: We identified 412 patients who were diagnosed with unilateral prostate cancer by biopsy and had undergone radical prostatectomy between 2009 and 2018. Among these patients, 111 underwent MRI before biopsy, had 10–20 core biopsies performed, and did not receive other treatments before surgery. Fifty-seven patients with prostate-specific antigen ≥ 15 ng/mL and biopsy Gleason score (GS) ≥ 4 + 3 were excluded. The remaining 54 patients were evaluated. Both lobes of the prostate were scored using Prostate Imaging Reporting and Data System version 2 on MRI. Ineligible patients for FT were defined as those with ≥ 0.5 mL GS6 or GS ≥ 3 + 4 in the biopsy-negative lobe, ≥ pT3, or lymph node involvement. Selected predictors of eligibility for hemi-ablative FT were analyzed. Results: Among our cohort of 54 patients, 29 (53.7%) were eligible for hemi-ablative FT. A multivariate analysis identified a PI-RADS score < 3 in the biopsy-negative lobe (p = 0.016) as an independent predictor of eligibility for FT. Thirteen out of 25 ineligible patients had GS ≥ 3 + 4 tumors in the biopsy-negative lobe, half of whom (6/13) also had a PI-RADS score < 3 in the biopsy-negative lobe. Conclusion: The PI-RADS score in the biopsy-negative lobe may be important in the selection of eligible candidates for FT. The findings of this study will help reduce missed significant prostate cancers and improve FT outcomes.

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Strategy for PSA progression in patients undergoing salvage radiation for biochemical recurrence after radical prostatectomy

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

International Journal of Clinical Oncology （International Journal of Clinical Oncology） 28 （ 5 ） 707 - 715 2023年05月

ISSN 13419625

Background: The treatment strategy for prostate-specific antigen (PSA) progression in patients who receive salvage radiation therapy (RT) for biochemical recurrence (BCR) after radical prostatectomy (RP) is salvage androgen deprivation therapy (ADT). However, its optimal timing is highly controversial. Methods: The study sample consisted of 77 men who underwent RP, received salvage RT against BCR, and underwent salvage ADT for PSA progression. The endpoint of this study was development to castration-resistant prostate cancer (CRPC), from the start of salvage RT. Results: The median follow-up time was 9.5 years, and 20 patients experienced CRPC. The multivariable analysis identified PSA-doubling time (PSA-DT) ≤ 12 months (hazard ratio, 3.5) and seminal vesicle invasion (SVI) (hazard ratio, 4.4) as independent risk factors. We defined the high-risk and low-risk groups as those with one or two risk factors and no risk factors, respectively. In the high-risk group, a significant difference in time to CRPC was observed between patients who received salvage ADT at PSA ≤ 1.0 ng/mL (n = 8) and at > 1.0 ng/mL (n = 27) (10-year non-CRPC rate: 100.0% vs. 46.3%, respectively). In contrast, in the low-risk group, no significant difference in CRPC-free survival was observed between patients who received salvage ADT at PSA ≤ 1.0 ng/mL (n = 14) and at > 1.0 ng/mL (n = 28) (10-year non-CRPC rate: 86.4% vs. 80.8%, respectively). Conclusion: In high-risk patients (PSA-DT ≤ 12 months and/or SVI), salvage ADT for PSA progression after salvage RT should be started before the PSA levels exceed 1.0 ng/mL.

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【どこまで変わるの?　腎細胞癌診療の進歩】診断　腎細胞癌の免疫微小環境

田中伸之, 大家基嗣

臨床泌尿器科（(株)医学書院） 77 （ 5 ） 322 - 326 2023年04月

ISSN 0385-2393

Single-Cell Phenotyping of CD73 Expression Reveals the Diversity of the Tumor Immune Microenvironment and Reflects the Prognosis of Bladder Cancer.

Izawa M, Tanaka N, Murakami T, Anno T, Teranishi Y, Takamatsu K, Mikami S, Kakimi K, Imamura T, Matsumoto K, Oya M

Laboratory investigation; a journal of technical methods and pathology （Laboratory investigation; a journal of technical methods and pathology） 103 （ 4 ） 100040 2023年01月

ISSN 0023-6837

The cutting edge of cancer immunotherapy extends to ecto-5'-nucleotidase (CD73), a cell membrane enzyme that targets the metabolism of extracellular adenosine. We herein focused on the expression of CD73 to clarify the state of CD73 positivity in cancer immunity and tumor microenvironment, thereby revealing a new survival predictor for patients with bladder cancer (BCa). We used clinical tissue microarrays of human BCa and simultaneously performed the fluorescent staining of cell type-specific markers (CD3, CD8, Foxp3, programmed cell death protein 1, and programmed death-ligand 1 [PD-L1]) and CD73 together with DAPI for nuclear staining. In total, 156 participants were included. Multiplexed cellular imaging revealed a unique interaction between CD73 expression and CD8+ cytotoxic T cells (CTLs) and Foxp3+ regulatory T (Treg) cells in human BCa, showing the high infiltration of CD8+CD73+ CTLs and Foxp3+CD73+ Treg cells in tumors to be associated with tumorigenesis and poor prognosis in BCa. Interestingly, from a biomarker perspective, the high infiltration of CD73+ Treg cells in tumors was identified as an independent risk factor for overall survival in addition to clinicopathologic features. Regarding the relationship between immune checkpoint molecules and CD73 expression, both CD73+ CTLs and CD73+ Treg cells tended to coexpress programmed cell death protein 1 as tumor invasiveness and nuclear grade increased. Additionally, they may occupy a spatial niche located distantly from PD-L1+ cells in tumors to interfere less with the cancerous effects of PD-L1+ cells. In conclusion, the present results on the status of CD73 in cancer immunity suggest that CD73 expression on specific T-cell types has a negative immunoregulatory function. These findings may provide further insights into the immunobiological landscape of BCa, which may be translationally linked to improvements in future immunotherapy practice.

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Predictors of urinary function recovery after laparoscopic and robot-assisted radical prostatectomy.

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

International braz j urol : official journal of the Brazilian Society of Urology （International braz j urol : official journal of the Brazilian Society of Urology） 49 （ 1 ） 50 - 60 2023年01月

ISSN 1677-5538

INTRODUCTION: Even in the era of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), we sometimes encounter patients with severe urinary incontinence after surgery. The aim of the present study was to identify predictors of urinary continence recovery among patients with urinary incontinence immediately after surgery (UIIAS). MATERIALS AND METHODS: We identified 274 patients with clinically localized prostate cancer who underwent LRP and RALP between 2011 and 2018. UIIAS was defined as a urine loss ratio > 0.15 on the first day of urethral catheter removal. Urinary continence recovery was defined as using ≤ 1 pad/day one year after surgery. In the present study, we evaluated factors affecting urinary function recovery one year after surgery among patients with urinary incontinence immediately after LRP and RALP. RESULTS: UIIAS was observed in 191 out of 274 patients (69.7%). A multivariate analysis identified age (<65 years, p = 0.015) as an independent predictor affecting immediate urinary continence. Among 191 incontinent patients, urinary continence one year after surgery improved in 153 (80.1%). A multivariate analysis identified age (<65 years, p = 0.003) and estimated blood loss (≥ 100 mL, p = 0.044) as independent predictors affecting urinary continence recovery one year after surgery. CONCLUSION: The present results suggest that younger patients and patients with higher intraoperative blood loss recover urinary continence one year after surgery even if they are incontinent immediately after surgery.

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