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  • Wiley  (31)
  • Takagi, Toshio  (31)
  • 1
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    Efficacy of nivolumab versus molecular‐targeted therapy as second‐line therapy for metastatic renal cell carcinoma: Real‐world data from two Japanese institutions
    Wiley ; 2021
    In:  International Journal of Urology Vol. 28, No. 1 ( 2021-01), p. 99-106
    Details
    In: International Journal of Urology, Wiley, Vol. 28, No. 1 ( 2021-01), p. 99-106
    Abstract: To compare the efficacy of nivolumab with that of molecular‐targeted therapy as a second‐line therapy for metastatic renal cell carcinoma using real‐world data. Methods We retrospectively evaluated patients who received nivolumab or molecular‐targeted therapy after the failure of first‐line molecular‐targeted therapy between January 2008 and December 2019 at two Japanese institutions. Progression‐free survival and overall survival after the initiation of second‐line therapy were calculated using the Kaplan‐Meier method and compared using the log‐rank test. Objective response rate was assessed based on the Response Evaluation Criteria in Solid Tumors version 1.1. Results Among 159 patients, 43 (27%) and 116 (73%) patients received nivolumab and molecular‐targeted therapy as second‐line therapy, respectively. During follow up (median 11.1 months), 129 (81%) and 98 (62%) patients had disease progression and died, respectively. Progression‐free survival was comparable between the two treatments (median 5.06 vs 5.95 months, P  = 0.881), whereas overall survival was significantly longer with nivolumab than with molecular‐targeted therapy (not reached vs 13.0 months, P  = 0.0008). Multivariate analysis further showed that nivolumab therapy was an independent favorable factor for overall survival (hazard ratio 0.33, P  = 0.0007). In 151 patients with eligible radiographic data, the objective response rate was significantly higher in nivolumab than in molecular‐targeted therapy ( n  = 14/41 [34%] vs n  = 20/110 [18%], P  = 0.0485). Conclusions Real‐world data analysis suggests superior efficacy of nivolumab over molecular‐targeted therapy as second‐line therapy for metastatic renal cell carcinoma.
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Issue
    URL: Article
    DOI: 10.1111/iju.v28.1
    DOI: 10.1111/iju.14412
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2009793-1
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  • 2
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    Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy
    Wiley ; 2015
    In:  International Journal of Urology Vol. 22, No. 4 ( 2015-04), p. 356-361
    Details
    In: International Journal of Urology, Wiley, Vol. 22, No. 4 ( 2015-04), p. 356-361
    Abstract: To investigate the incidence of asymptomatic unruptured renal artery pseudoaneurysm detected by 3‐D computed tomography arteriography in the early period after minimally invasive partial nephrectomy, including laparoscopic and robotic partial nephrectomy. Methods From February 2012 to November 2013, 101 patients underwent minimally invasive partial nephrectomy for renal masses. Computed tomography arteriography was carried out 3–4 days after surgery; radiologists diagnosed renal artery pseudoaneurysm in a blinded manner. Factors influencing the occurrence of renal artery pseudoaneurysm were analyzed with the logistic regression model. Results The incidence of renal artery pseudoaneurysm was unexpectedly high at 21.7% when detected by computed tomography arteriography during the early period after minimally invasive partial nephrectomy. The renal artery pseudoaneurysm group showed a significantly larger tumor size ( P  = 0.02), significantly higher N component score ( P  = 0.01) and higher incidence of renal sinus exposure or opening of the collecting system ( P   〈  0.01) compared with the no renal artery pseudoaneurysm group. Although these aforementioned factors were found to be significant by univariate analysis, multivariate analysis showed that renal sinus exposure was the only significant independent predictive factor for occurrence of renal artery pseudoaneurysm. Tumor‐related factors, such as the N component of the nephrometry scoring system or tumor size, did not show an independent influence on the occurrence of renal artery pseudoaneurysm. Conclusions The present study shows an unexpectedly high incidence of asymptomatic unruptured renal artery pseudoaneurysm detected by computed tomography arteriography in the early period after minimally invasive partial nephrectomy. Renal sinus exposure is an independent significant factor predicting the occurrence of renal artery pseudoaneurysm. Avoidance of deep excision into the renal sinus could reduce the risk of renal artery pseudoaneurysm. © 2015 The Japanese Urological Association
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Issue
    URL: Article
    DOI: 10.1111/iju.v22.4
    DOI: 10.1111/iju.12696
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 3
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    Assessment of postoperative renal function after adrenalectomy in patients with primary aldosteronism
    Wiley ; 2019
    In:  International Journal of Urology Vol. 26, No. 2 ( 2019-02), p. 229-233
    Details
    In: International Journal of Urology, Wiley, Vol. 26, No. 2 ( 2019-02), p. 229-233
    Abstract: To investigate kidney function change during adrenalectomy in patients with primary aldosteronism and assess predictors of kidney function decline. Methods The present study included 90 patients who underwent adrenalectomy for primary aldosteronism between 2004 and 2017. Kidney function was evaluated 1 month after surgery. Predictors associated with a ≥10% decline in the estimated glomerular filtration rate were investigated. Kidney parenchymal volume was compared before and after surgery in 10 patients using volumetric studies. Results The mean estimated glomerular filtration rate decline in the total cohort at 1 month after surgery was 13.3% (before: 72.9  mL /min/1.73 m 2 , after: 64.9  mL /min/1.73 m 2 , P   〈  0.0001). The mean serum plasma aldosterone concentration (before: 373 pg/ mL vs after: 78 pg/ mL , P   〈  0.0001) and potassium level (before: 3.7  mE q/L vs after: 3.9  mE q/L, P  = 0.0001) were also significantly different after surgery. Age (odds ratio 6.37, P  = 0.0006), preoperative plasma aldosterone concentration (odds ratio 3.12, P  = 0.0209) and preoperative serum potassium level (odds ratio 2.87, P  = 0.0010) were independent predictors of a ≥10% decline in estimated glomerular filtration rate. Volumetric studies in 10 patients showed that mean postoperative parenchymal volume was significantly decreased compared with the preoperative volume (263 cc vs 312 cc, P  = 0.0003), with decreases in estimated glomerular filtration rate from 63 to 56  mL /min/1.73 m 2 ( P  = 0.0146). Conclusions Kidney function deterioration after adrenalectomy can be detected in patients with primary aldosteronism. Age, preoperative plasma aldosterone concentration and preoperative potassium level are significant predictors of a decrease in the estimated glomerular filtration rate. Normal parenchymal volume decreases in line with renal functional deterioration.
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Issue
    URL: Article
    DOI: 10.1111/iju.2019.26.issue-2
    DOI: 10.1111/iju.13844
    Language: English
    Publisher: Wiley
    Publication Date: 2019
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  • 4
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    Negative impact of papillary histological subtype in patients with renal cell carcinoma extending into the inferior vena cava: Single‐center experience
    Wiley ; 2013
    In:  International Journal of Urology Vol. 20, No. 11 ( 2013-11), p. 1072-1077
    Details
    In: International Journal of Urology, Wiley, Vol. 20, No. 11 ( 2013-11), p. 1072-1077
    Abstract: To investigate the impact of histological subtypes on the survival of patients presenting with renal cell carcinoma extending into the inferior vena cava. Methods From J anuary 1985 until O ctober 2011, 68 patients with renal cell carcinoma extending into the inferior vena cava underwent radical nephrectomy and inferior vena cava thrombectomy at Tokyo Women's Medical University, Tokyo, Japan. Their clinical and pathological parameters were reviewed from the medical charts. Results The median follow up was 19 months (range 0.1–144 months). The tumor thrombus level was I in four patients (6%), II in 38 patients (56%), III in 12 patients (18%) and IV in 14 patients (20%). Papillary histological subtype was found in seven patients (10%), and clear cell in 61 patients (90%). Patients with a papillary subtype had a significantly worse survival outcome than the patients with the clear cell subtype (median survival time 9.0 vs 36.1 months, P   〈  0.001). Multivariate analysis also showed that the papillary subtype was the only independent prognostic factor for unfavorable cancer‐specific survival ( P  = 0.03). When the patients presented with metastases to lymph nodes or distant metastases, the median survival of the patients with a papillary subtype was extremely short, at just 5.2 months compared with those with a clear cell subtype (24.0 months, P  = 0.001). Conclusions Patients with renal cell carcinoma extending into the inferior vena cava with a papillary subtype show a considerably shorter survival compared with those with a clear cell subtype. The papillary renal cell carcinoma extending into the inferior vena cava patient might be an inappropriate candidate for extensive surgery when metastases to nodes or distant organs are found.
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Issue
    URL: Article
    DOI: 10.1111/iju.2013.20.issue-11
    DOI: 10.1111/iju.12123
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 5
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    Association between tumor contact surface area and parenchymal volume change in robot‐assisted laparoscopic partial nephrectomy carried out using the enucleation technique
    Wiley ; 2019
    In:  International Journal of Urology Vol. 26, No. 7 ( 2019-07), p. 745-751
    Details
    In: International Journal of Urology, Wiley, Vol. 26, No. 7 ( 2019-07), p. 745-751
    Abstract: To evaluate the change in the operated parenchymal volume during robot‐assisted partial nephrectomy limited to the enucleation technique, and to analyze the predictors of decrease in operated parenchymal volume, including the tumor contact surface area. Methods The study included 135 patients who underwent robot‐assisted partial nephrectomy for T1 renal tumors using the enucleation technique. Measurements of the parenchymal volume, tumor volume and contact surface area were obtained in the venous phase on enhanced computed tomography. All measurements, including volumetric and renal function analysis, were carried out 〈 2 months before and 6 months after surgery. Results The mean age of included participants was 56 years, and the mean tumor size was 33 mm. The mean tumor volume was 26 cc, and the mean contact surface area was 22 cm 2 . In the complete cohort, the mean preoperative and postoperative normal parenchymal volumes of the operated kidney were 158 and 141 cc, respectively. The mean change in parenchymal volume of the operated kidney was −10%. In contrast, the mean change in global estimated glomerular filtration was just −4.0%. Univariate analysis showed that the RENAL nephrometry score, contact surface area, tumor volume and warm ischemia time were associated with the change in the operated kidney parenchymal volume. However, in the multivariate analysis, a large contact surface area was the only independent predictor of decreased operated parenchymal volume 〈 10 cm 3 . Conclusion Contact surface area is a strong predictor of the decrease in the parenchymal volume in the operated kidney during robot‐assisted partial nephrectomy carried out using the enucleation technique for T1 renal tumors.
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Issue
    URL: Article
    DOI: 10.1111/iju.2019.26.issue-7
    DOI: 10.1111/iju.14004
    Language: English
    Publisher: Wiley
    Publication Date: 2019
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  • 6
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    Template‐based lymphadenectomy in urothelial carcinoma of the renal pelvis: A prospective study
    Wiley ; 2014
    In:  International Journal of Urology Vol. 21, No. 5 ( 2014-05), p. 453-459
    Details
    In: International Journal of Urology, Wiley, Vol. 21, No. 5 ( 2014-05), p. 453-459
    Abstract: Recent studies showed the therapeutic benefit of lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. The aim of this multi‐institutional study was to examine the role of lymphadenectomy in urothelial carcinoma of the upper urinary tract. Methods From J anuary 2005 to S eptember 2012, 77 patients undergoing nephroureterectomy and lymphadenectomy for non‐metastatic ( cN0M0 ) urothelial carcinoma of the upper urinary tract were included in a prospective study at two J apanese institutions (lymphadenectomy group). Lymphadenectomies were carried out according to definite anatomical template. Results from this group were compared with those from a control group of 89 patients who did not receive lymphadenectomy during the study period (no lymphadenectomy group). Results In patients with urothelial carcinoma of the upper urinary tract in the renal pelvis of pathological stage 2 or higher, template‐based lymphadenectomy resulted in significantly higher cancer‐specific survival (89.8% and 51.7%, P  = 0.01) and overall survival (86.1% and 48.0%, P  = 0.01). Disease‐free survival tended to be higher in the lymphadenectomy group (77.8% and 50.0%, P  = 0.06). Template‐based lymphadenectomy was a significant independent factor for reducing the risk of cancer death in patients with renal pelvic cancer of ≥ pT2 by multivariate analysis. In contrast, cancer‐specific survival of patients with ureteral urothelial carcinoma of the upper urinary tract was not significantly different between the lymphadenectomy and no lymphadenectomy groups. Conclusions This multi‐institutional prospective study further supports the therapeutic role of template‐based lymphadenectomy in patients with advanced‐stage urothelial carcinoma of the upper urinary tract in the renal pelvis. This is not the case for patients with ureteral urothelial carcinoma of the upper urinary tract.
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Issue
    URL: Article
    DOI: 10.1111/iju.2014.21.issue-5
    DOI: 10.1111/iju.12338
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 7
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    Early unclamping might reduce the risk of renal artery pseudoaneurysm after robot‐assisted laparoscopic partial nephrectomy
    Wiley ; 2015
    In:  International Journal of Urology Vol. 22, No. 12 ( 2015-12), p. 1096-1102
    Details
    In: International Journal of Urology, Wiley, Vol. 22, No. 12 ( 2015-12), p. 1096-1102
    Abstract: To determine the influence of the early unclamping technique on the risk of renal artery pseudoaneurysm during robot‐assisted laparoscopic partial nephrectomy. Methods From January 2013 to October 2014, 96 patients underwent robot‐assisted laparoscopic partial nephrectomy for renal masses at Tokyo Women's Medical University Hospital, Tokyo, Japan. Computed tomography angiography was carried out 3–4 days after surgery. Early in the series, renal hilum was left unclamped and renorrhaphy was subsequently carried out (conventional unclamping technique). An early unclamping technique has been used since November 2013. Results A total of 61 patients underwent robot‐assisted laparoscopic partial nephrectomy with early unclamping, and 35 patients underwent robot‐assisted laparoscopic partial nephrectomy with conventional unclamping. Ischemia time was significantly shorter in the early unclamping group (16.5 vs 23.1 min; P   〈  0.01). The early unclamping group showed a significantly lower incidence of asymptomatic renal artery pseudoaneurysm relative to the conventional unclamping group (11.4% vs 28.6%; P  = 0.03). Multivariate analysis showed that the early unclamping technique was a significant independent factor in reducing the risk of renal artery pseudoaneurysm (hazard ratio 0.27; P  = 0.01). Conclusions The present findings suggest that an early unclamping technique might reduce ischemic time and risk of renal artery pseudoaneurysm. The absence of arterial bleeding before renorrhaphy is likely to be a key step in preventing renal artery pseudoaneurysm during robot‐assisted laparoscopic partial nephrectomy.
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Issue
    URL: Article
    DOI: 10.1111/iju.2015.22.issue-12
    DOI: 10.1111/iju.12902
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 8
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    Renal cell carcinoma outcomes in end‐stage renal disease: A 40‐year study from two Japanese institutions
    Wiley ; 2023
    In:  International Journal of Urology
    Details
    In: International Journal of Urology, Wiley
    Abstract: The objective of the study was to analyze the outcomes of patients with renal cell carcinoma (RCC) arising in end‐stage renal disease (ESRD) over a 40‐year span. Methods We retrospectively evaluated data of patients with ESRD‐RCC diagnosed between 1979 and 2020 at two institutions. We assessed changes in stage, surgical approaches, and cancer‐specific survival (CSS) following nephrectomy according to era between ESRD‐RCC and sporadic RCC. Furthermore, perioperative outcomes in patients with ESRD‐RCC were compared between laparoscopic and open surgery. Results Patients with ESRD‐RCC ( n  = 549) were diagnosed at an earlier stage ( p  = 0.0276), and the ratio of laparoscopic nephrectomy was increased ( p   〈  0.0001) according to eras. Since 2000 (i.e., after implementation of laparoscopic nephrectomy), patients with ESRD‐RCC ( n  = 305) had significantly shorter CSS ( p  = 0.0063) after nephrectomy than sporadic RCC ( n  = 2732). After adjustment by multivariate analysis and propensity score matching, ESRD status was independently associated with shorter CSS ( p  = 0.0055 and p  = 0.0473, respectively). Improved CSS in sporadic RCC ( p   〈  0.0001), but not ESRD‐RCC ( p  = 0.904), according to era contributed to this difference. Laparoscopic nephrectomy showed favorable outcomes, including shorter surgery time, lower estimated bleeding volumes, transfusion rates, and readmission rates, and shorter postoperative hospitalization than open nephrectomy ( p   〈  0.05). Conclusions Advances in diagnostic and treatment modalities potentially enable early diagnosis and minimally invasive surgery for patients with ESRD‐RCC. As ESRD‐RCC may not present indolently, careful post‐operative monitoring is needed.
    Type of Medium: Online Resource
    ISSN: 0919-8172 , 1442-2042
    URL: Article
    DOI: 10.1111/iju.15314
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 9
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    Incidental detection of asymptomatic migration of Hem‐o‐lok clip into the bladder after laparoscopic radical prostatectomy
    Wiley ; 2017
    In:  Asian Journal of Endoscopic Surgery Vol. 10, No. 4 ( 2017-11), p. 442-445
    Details
    In: Asian Journal of Endoscopic Surgery, Wiley, Vol. 10, No. 4 ( 2017-11), p. 442-445
    Abstract: Hem‐o‐lok clips have been widely used in laparoscopic or robot‐assisted surgery. We report a case of an incidentally discovered Hem‐o‐lok migration into the bladder after laparoscopic radical prostatectomy. The patient was a 75‐year‐old man with localized prostate cancer who underwent laparoscopic radical prostatectomy in July 2009. At 3 postoperative years, follow‐up ultrasonography revealed a small round mass in the bladder. No lower urinary tract symptoms were reported, and urinalysis results had never indicated hematuria or pyuria. Cystoscopy revealed a Hem‐o‐lok clip in the bladder, near the vesicourethral anastomotic site. We could not remove it with forceps in the outpatient clinic, so we performed the procedure again under general anesthesia and successfully removed the Hem‐o‐lok clip. To our knowledge, this is the first report of an asymptomatic Hem‐o‐lok migration into the bladder.
    Type of Medium: Online Resource
    ISSN: 1758-5902 , 1758-5910
    URL: Issue
    URL: Article
    DOI: 10.1111/ases.2017.10.issue-4
    DOI: 10.1111/ases.12384
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2492135-X
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  • 10
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    Possible abscopal effect in urothelial carcinoma of the upper urinary tract after treatment with immune checkpoint inhibitors
    Wiley ; 2020
    In:  IJU Case Reports Vol. 3, No. 1 ( 2020-01), p. 25-27
    Details
    In: IJU Case Reports, Wiley, Vol. 3, No. 1 ( 2020-01), p. 25-27
    Abstract: Regression of non‐irradiated metastatic lesions after radiation therapy is known as the abscopal effect. We report a case of urothelial carcinoma in which the abscopal effect was possibly observed after immune checkpoint inhibitor administration. Case presentation A 68‐year‐old woman diagnosed with left renal pelvic cancer underwent total nephroureterectomy and regional lymph node dissection. Eight months later, imaging studies detected local recurrence and paraaortic lymph node metastasis. The tumor progressed despite cisplatin + gemcitabine, pembrolizumab, and gemcitabine + docetaxel therapy. Radiation therapy was administered to a painful back lesion, which resulted in dramatic symptom relief. Computed tomography 2 months after radiation therapy indicated reduced size of the irradiated lesion and some non‐irradiated lymph nodes. Conclusion Combined radiation therapy and immune checkpoint inhibitors can provide additional benefits for certain cancers, possibly due to negative immunomodulatory response blockade. Thus, this combined therapy may be a new metastatic urothelial carcinoma treatment strategy.
    Type of Medium: Online Resource
    ISSN: 2577-171X , 2577-171X
    URL: Issue
    URL: Article
    DOI: 10.1002/iju5.v3.1
    DOI: 10.1002/iju5.12133
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2971934-3
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