論文

• External validation of a motion capture-based surgical skill assessment system in laparoscopic simulation training environments.
  Koki Ebina, Takashige Abe, Kiyohiko Hotta, Yan Lingbo, Chihiro Kamijo, Madoka Higuchi, Masafumi Kon, Hiroshi Kikuchi, Haruka Miyata, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Taku Senoo, Shunsuke Komizunai, Teppei Tsujita, Kazuya Sase, Xiaoshuai Chen, Atsushi Konno, Nobuo Shinohara
  Surgical endoscopy, 39, 9, 5879, 5888, 2025年09月, ［国際誌］
  英語, 研究論文（学術雑誌）, PURPOSE: To externally validate our surgical skill assessment system, which provides comprehensive real-time feedback based on motion capture (Mocap) metrics of laparoscopic instruments in simulation training environments. METHODS: Participants conducted periaortic tissue dissection (Dissection Task) and parenchymal closure of the kidney (Suturing Task) using porcine cadaveric organs. Surgical instrument movements were measured by the MoCap system, and all training sessions were video-recorded. Utilizing our previously developed machine-learning (ML) algorithm, participants received quantitative feedback based on their motion features immediately after the training, including three-tier classification results, which meant their skill levels being consistent with those with 0 ≤ to ≤ 9 surgical caseloads of laparoscopy (novice), 10 ≤ to ≤ 49 (intermediate), and ≥ 50 (experienced), and predicted Global Operative Assessment of Laparoscopic Skills (GOALS) scores. Automatically generated feedback comments were also provided through explainable artificial intelligence technology, and participants' satisfaction with this skill assessment system was also recorded. For the three-tier classifications, accuracy was calculated by comparison between estimated and actual surgical experience levels. The correlation and mean absolute error (MAE) were calculated between the algorithm-predicted and expert-evaluated mean GOALS scores. RESULTS: A total of 38 urologists, 4 junior residents, and 10 medical students voluntarily participated in the current training. Several participants repeatedly performed the training, and so 107 datasets were included in the present analysis. Validation analyses demonstrated overall classification accuracies of 67.3 and 56.9% for Dissection Task and Suturing Task, respectively, when excluding the subsequent data of repeaters. In terms of GOALS score prediction, the correlation coefficient and MAE were 0.86 and 2.51 ± 1.82 for Dissection Task, and 0.91 and 1.56 ± 1.20 for Suturing Task, respectively, when compared with experts' evaluations. Overall, 88% of the participants found the feedback easy to understand, and 75% of participants were satisfied with the evaluation. CONCLUSIONS: Our real-time feedback system was viewed favorably by the participants, and the ML algorithm was a reliable method, especially the predicted GOALS score. This system could facilitate objective performance assessment, enhance simulation-based training efficacy, and potentially accelerate surgical skill acquisition.
• Current Landscape of Urological Surgical Training: A Needs Assessment Survey in Japan.
  Noriyuki Abe, Takashige Abe, Kanta Hori, Junya Abe, Kazufumi Okada, Keita Takahashi, Shigeru Harada, Masafumi Kon, Jun Furumido, Kohei Hashimoto, Sachiyo Murai, Hiroshi Kikuchi, Naoya Masumori, Hidehiro Kakizaki, Nobuo Shinohara
  International journal of urology : official journal of the Japanese Urological Association, 32, 7, 811, 820, 2025年07月, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVES: To clarify the present state and issues to be resolved in urological surgical training in Japan. METHODS: A web-based needs assessment survey was conducted, inviting urologists belonging to three university hospitals and 34 affiliated hospitals in Hokkaido, Japan. Physicians with less than 15 years of experience were defined as trainees, and those with more than 15 years were defined as instructors. The survey investigated the current surgical education, training environments, and issues to be resolved. RESULTS: The response rate was 98.2% (169/172). Overall, the current surgical training in our cohort largely depended on "on-the-job" training. Regarding the effectiveness of surgical education materials, teaching in the operating room during procedures gained the highest scores for both trainees and instructors, followed by review of operative movies. Regarding the dedicated time for studying/training/teaching apart from routine clinical duties, 87.1% (74/85) of trainees and 96.4% (81/84) of instructors did not have any time. A total of 58.8% (50/85) of trainees considered open surgery to be undertrained, while only 8.3% (7/84) of instructors considered that open surgery was difficult to teach in their hospitals. Among instructors, 54.8% (46/84) acknowledged limitations regarding the current training program. CONCLUSIONS: The current surgical training in urology in Hokkaido, Japan, largely depends on "on-the-job" training methods. About two-thirds of trainees consider open surgery to be undertrained. Our observations could be utilized to update the training curriculum in Japan.
• Characteristics of patients with metastatic renal cell carcinoma who do not respond to axitinib treatment.
  Kojiro Ohba, Takahiro Osawa, Takahiro Kojima, Tomohiko Hara, Mikio Sugimoto, Masatoshi Eto, Keita Minami, Yasutomo Nakai, Kosuke Ueda, Sei Naito, Norio Nonomura, Sachiyo Murai, Hiroyuki Nishiyama, Hiromi Nakanishi, Yuta Mukae, Kensuke Mitsunari, Tomohiro Matsuo, Ryoichi Imamura, Nobuo Shinohara
  International journal of clinical oncology, 30, 4, 781, 788, 2025年04月, ［国内誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Axitinib is a widely used tyrosine kinase inhibitor (TKI) in metastatic renal cell carcinoma (mRCC) treatment. Here, we analyzed the characteristics of patients who did not respond to axitinib and evaluated alternative options for their treatment. METHODS: We retrospectively analyzed data for 449 patients with mRCC who were administered axitinib following another TKI as initial therapy. Patients with progressive disease (PD) at their first assessment were defined as showing early-PD. We analyzed the characteristics of patients at risk of early-PD and evaluated the relationship between the treatment following axitinib and their prognosis. RESULTS: Early-PD was diagnosed in 102 patients, and was more common in those who had not undergone nephrectomy (p < 0.001), those treated with a TKI for a short period (p < 0.001), and those in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) poor risk category for mRCC (p < 0.001). Multivariate analysis showed that these were independent risk factors for early-PD (all p < 0.001). Of those with early-PD, 52 changed to next-line treatment. The progression-free survival periods were 5.5 (95% confidence interval (CI) 2.4-8.6) months for patients administered TKIs, 4.2 (95% CI 0.3-8.1) months for those on nivolumab, and 2.2 (1.8-2.6) months for those on mammalian target of rapamycin inhibitors (p = 0.030). CONCLUSION: Patients who have not undergone nephrectomy, those previously treated with another TKI for a short period, and those in the IMDC poor risk category are more likely to experience early-PD when taking axitinib. Furthermore, TKIs are the best treatment for patients with early-PD who have previously been administered axitinib.
• Decision regret after curative treatment and its association with the decision-making process and quality of life for prostate cancer patients.
  Miho Sato, Takahiro Osawa, Kentaro Nishioka, Tomohiko Miyazaki, Shuhei Takahashi, Takashi Mori, Takayuki Hashimoto, Haruka Miyata, Ryuji Matsumoto, Takashige Abe, Kazuki Ohashi, Sachiyo Murai, Yoichi M Ito, Nobuo Shinohara
  International journal of urology : official journal of the Japanese Urological Association, 2024年10月09日, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVES: To determine how the treatment decision-making process and posttreatment health-related quality of life (HRQOL) are related to regret about treatment choice for prostate cancer patients in Japan. METHODS: We invited a total of 614 patients who were treated with radiation therapy (RT), radical prostatectomy (RP), or active surveillance/watchful waiting (AS/WW) from April 2007 to March 2021. Posttreatment regret was evaluated by the Decision Regret Scale. HRQOL was evaluated by the Expanded Prostate Cancer Index Composite and the 12-item Short Form Survey. The decision-making process was assessed by patient evaluation of the decision-making process. We compared the decision regret scale scores across treatment types, HRQOL, and decision-making processes. RESULTS: Data from 371 patients were analyzed (RT: 202, RP: 149, AS/WW: 20). The median length of time since treatment was 64 (IQR: 43-93) months. The decision regret scale scores were not significantly different among the treatment groups but were significantly greater (strong regret) in patients with poor urinary summary scores, bowel summary scores, and hormonal summary scores. The decision regret scale scores were significantly lower (less regret) for patients who reported being adequately informed at the time of the treatment decision and who had adequately communicated their questions and concerns to physicians than for patients who reported less adequate communication. This result was also observed among patients who reported low HRQOL scores. CONCLUSIONS: These findings underline the important influence of posttreatment HRQOL and decision-making as an interactive process between physicians and their patients on posttreatment regret in prostate cancer patients.
• 前立腺がん患者における治療決定時の意思決定プロセスと治療後の後悔との関連　　　　　　　　　　　　　　　
  佐藤 三穂, 大澤 崇宏, 宮田 遥, 松本 隆児, 安部 崇重, 西岡 健太郎, 宮崎 智彦, 高橋 周平, 森 崇, 橋本 孝之, 大橋 和貴, 村井 祥代, 伊藤 陽一, 篠原 信雄
  日本癌治療学会学術集会抄録集, 62回, YOA O22, 5, (一社)日本癌治療学会, 2024年10月
  日本語
• Surgical skill analysis focused on tissue traction in laparoscopic wet lab training.
  Koki Ebina, Takashige Abe, Madoka Higuchi, Kiyohiko Hotta, Jun Furumido, Naoya Iwahara, Taku Senoo, Shunsuke Komizunai, Teppei Tsujita, Kazuya Sase, Xiaoshuai Chen, Yo Kurashima, Hiroshi Kikuchi, Haruka Miyata, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Atsushi Konno, Nobuo Shinohara
  Surgery open science, 21, 7, 13, 2024年09月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Tissue handling is one of the pivotal parts of surgical procedures. We aimed to elucidate the characteristics of experts' left-hand during laparoscopic tissue dissection. METHODS: Participants performed tissue dissection around the porcine aorta. The grasping force/point of the grasping forceps were measured using custom-made sensor forceps, and the forceps location was also recorded by motion capture system (Mocap). According to the global operative assessment of laparoscopic skills (GOALS), two experts scored the recorded movies, and based on the mean scores, participants were divided into three groups: novice (<10), intermediate (10≤ to <20), and expert (≤20). Force-based metrics were compared among the three groups using the Kruskal-Wallis test. Principal component analysis (PCA) using significant metrics was also performed. RESULTS: A total of 42 trainings were successfully recorded. The statistical test revealed that novices frequently regrasped a tissue (median total number of grasps, novices: 268.0 times, intermediates: 89.5, experts: 52.0, p < 0.0001), the traction angle became stable against the aorta (median weighted standard deviation of traction angle, novices: 30.74°, intermediates: 26.80, experts: 23.75, p = 0.0285), and the grasping point moved away from the aorta according to skill competency [median percentage of grasping force applied in close zone (0 to 2.0 cm from aorta), novices: 34.96 %, intermediates: 21.61 %, experts: 10.91 %, p = 0.0032]. PCA showed that the efficiency-related (total number of grasps) and effective tissue traction-related (weighted average grasping position in Y-axis and distribution of grasping area) metrics mainly contributed to the skill difference (proportion of variance of first principal component: 60.83 %). CONCLUSION: The present results revealed experts' left-hand characteristics, including correct tissue grasping, sufficient tissue traction from the aorta, and stable traction angle. Our next challenge is the provision of immediate and visual feedback onsite after the present wet-lab training, and shortening the learning curve of trainees.
• A prospective study of surgeons' workloads and associated factors in real-world practice.
  Shigeru Harada, Takashige Abe, Jun Furumido, Keita Takahashi, Kanta Hori, Noriyuki Abe, Masafumi Kon, Sachiyo Murai, Haruka Miyata, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Nobuo Shinohara
  Scientific reports, 14, 1, 9741, 9741, 2024年04月28日, ［国際誌］
  英語, 研究論文（学術雑誌）, New technologies such as laparoscopic and robotic surgery are spreading, and there is a demand for physicians to keep up with novel methods. In contrast to the recent focus on healthcare professional burnout, the mental and physical costs during surgery are not well-understood. We aimed to quantify surgeons' workloads in daily urological surgical practice and clarify potential background factors associated with such workloads. Urologists in Hokkaido, Japan, were invited to this study. Between December 2020 and December 2021, participants repeatedly reported workloads, which were assessed using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), after each surgery in conjunction with participants' names, patients' backgrounds, their roles (independent operator, operator under supervision, instructor, and 1st or 2nd assistant), and surgical outcomes, via SurveyMonkey®. Because of the heterogeneity among individuals, a linear mixed-effects model was utilized to analyze factors associated with NASA-TLX, calculating the parameter estimates (PE) of regression coefficients for each factor and their 95% confidence interval (CI). Sixty-five urologists (5 women) joined the study, and 2169 data were collected within 7 days after surgeries. A linear mixed-effects model revealed that female surgeons (PE + 15.56, 95% CI 2.36-28.77), urgent/emergency surgery (PE + 6.65, 95% CI 4.59-8.70), intraoperative complications (PE + 9.26, 95% CI 6.76-11.76), and near-miss incidents (PE + 3.81, 95% CI 2.27-5.36) were associated with higher workloads. Regarding the surgeons' role, operator under supervision (PE + 12.46, 95% CI 9.86-15.06) showed the highest workloads. Surgeons' workloads decreased as the number of previous cases of the same procedure increased. Surgeons' workloads were associated with various factors. Given that the highest workloads were for operators under supervision, instructors should be aware of trainees' high workloads and devise appropriate instructional interventions.
• Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial.
  Mifuka Ouchi, Takeya Kitta, Hiroki Chiba, Madoka Higuchi, Yui Abe-Takahashi, Mio Togo, Naohisa Kusakabe, Sachiyo Murai, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Takashige Abe, Nobuo Shinohara
  BJU international, 2024年04月24日, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS: We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score. RESULTS: Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores. CONCLUSION: Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP.
• Cross-sectional and longitudinal analyses of urinary extracellular vesicle mRNA markers in urothelial bladder cancer patients.
  Taku Murakami, Keita Minami, Toru Harabayashi, Satoru Maruyama, Norikata Takada, Akira Kashiwagi, Haruka Miyata, Yasuyuki Sato, Ryuji Matsumoto, Hiroshi Kikuchi, Takashige Abe, Yoichi M Ito, Sachiyo Murai, Nobuo Shinohara, Hiroshi Harada, Takahiro Osawa
  Scientific reports, 14, 1, 6801, 6801, 2024年03月21日, ［国際誌］
  英語, 研究論文（学術雑誌）, We designed this multi-center prospective study with the following objectives: (1) the cross-sectional validation of extracellular vesicles (EV) mRNA markers to detect urothelial bladder cancer (UBC) before transurethral resection of bladder cancer (TURBT), and (2) the longitudinal validation of EV mRNA markers to monitor non-muscle invasive bladder cancer (NMIBC) recurrence after TURBT. EV mRNA markers evaluated in this study were KRT17, GPRC5A, and SLC2A1 in addition to two additional markers from literatures, MDK and CXCR2, and measured by quantitative RT-PCR with normalization by a reference gene (ALDOB). Diagnostic performances of EV mRNA markers were compared to conventional markers. Regarding the first objective, we confirmed that EV mRNA biomarkers in urine were higher in UBC patients, particularly those with higher stage/grade tumors, than in those without UBC (n = 278 in total) and the diagnostic performance of EV mRNA MDK and KRT17 outperformed conventional biomarkers with AUC 0.760 and 0.730, respectively. Concerning the second objective, we prospectively analyzed the time courses of EV mRNA markers while NMIBC patients (n = 189) (median follow-up 19 months). The expression of EV mRNA KRT17 was significantly high in patients with recurrence, while it gradually decreased over time in those without recurrence (p < 0.01).
• Gap analysis between trainees' subjective competencies and the competencies expected by instructors in urology: A need assessment survey in Japan
  Kanta Hori, Takashige Abe, Noriyuki Abe, Junya Abe, Kazufumi Okada, Keita Takahashi, Shigeru Harada, Jun Furumido, Sachiyo Murai, Masafumi Kon, Kohei Hashimoto, Naoya Masumori, Hidehiro Kakizaki, Nobuo Shinohara
  International Journal of Urology, Wiley, 2024年02月17日
  研究論文（学術雑誌）, Objective
  
  According to the rapid progress in surgical techniques, a growing number of procedures should be learned during postgraduate training periods. This study aimed to clarify the current situation regarding urological surgical training and identify the perception gap between trainees' competency and the competency expected by instructors in Japan.
  
  Methods
  
  Regarding the 40 urological surgical procedures selected via the Delphi method, we collected data on previous caseloads, current subjective autonomy, and confidence for future skill acquisition from trainees (<15 post‐graduate years [PGY]), and the competencies when trainees became attending doctors expected by instructors (>15 PGY), according to a 5‐point Likert scale. In total, 174 urologists in Hokkaido Prefecture, Japan were enrolled in this study.
  
  Results
  
  The response rate was 96% (165/174). In a large proportion of the procedures, caseloads grew with accumulation of years of clinical practice. However, trainees had limited caseloads of robotic and reconstructive surgeries even after 15 PGY. Trainees showed low subjective competencies at present and low confidence for future skill acquisition in several procedures, such as open cystectomy, ureteroureterostomy, and ureterocystostomy, while instructors expected trainees to be able to perform these procedures independently when they became attending doctors.
  
  Conclusion
  
  Trainees showed low subjective competencies and low confidence for future skill acquisition in several open and reconstructive procedures, while instructors considered that these procedures should be independently performable by attending doctors. We believe that knowledge of these perception gaps is helpful to develop a practical training program.
• 増やそう未来の外科医!働き方改革における外科系教育 泌尿器科手術に関するシミュレーショントレーニング 当科での経験　　　　　　　　　　　　　　　
  安部 崇重, 今 雅史, 樋口 まどか, 堀田 記世彦, 菊地 央, 古御堂 純, 岩原 直也, 山田 修平, 原田 茂, 上條 千太, 村井 祥代, 宮田 遥, 松本 隆児, 大澤 崇宏, 篠原 信雄
  日本癌治療学会学術集会抄録集, 61回, SWS7, 1, (一社)日本癌治療学会, 2023年10月
  英語
• 膀胱癌術後患者における日本語版Body Image Scaleの信頼性と妥当性の検証
  樋口 まどか, 佐藤 三穂, 大澤 崇宏, 山田 修平, 宮田 遥, 松本 隆児, 田中 博, 佐々木 芳浩, 森田 研, 原林 透, 柏木 明, 村井 祥代, 安部 崇重, 小笠原 克彦, 篠原 信雄
  泌尿器外科, 36, 臨増, 886, 886, 医学図書出版(株), 2023年08月
  日本語
• Impact of postoperative complications on long-term survival in bladder cancer patients.
  Takashige Abe, Shuhei Yamada, Hiroshi Kikuchi, Ataru Sazawa, Hidenori Katano, Hidetaka Suzuki, Ichiro Takeuchi, Keita Minami, Ken Morita, Kunihiko Tsuchiya, Norikata Takada, Shintaro Maru, Soshu Sato, Takanori Yamashita, Tango Mochizuki, Tomoshige Akino, Yoshihiro Sasaki, Yuichiro Shinno, Norihiro Murahashi, Takafumi Kawazu, Jun Furumido, Haruka Miyata, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Nobuo Shinohara
  Japanese journal of clinical oncology, 2023年07月17日, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: To determine the impact of postoperative complications on long-term survival outcomes in patients with bladder cancer undergoing radical cystectomy. METHODS: This retrospective multi-institutional study included 766 bladder cancer patients who underwent radical cystectomy between 2011 and 2017. Patient characteristics, perioperative outcomes, all complications within 90 days after surgery and survival outcomes were collected. Each complication was graded based on the Clavien-Dindo system, and grouped using a standardized grouping method. The Comprehensive Complication Index, which incorporates all complications into a single formula weighted by their severity, was utilized. Overall survival and recurrence-free survival (local, distant or urothelial recurrences) were stratified by Comprehensive Complication Index (high: ≥26.2; low: <26.2). A multivariate model was utilized to identify independent prognostic factors. RESULTS: The incidence of any and major complications (≥Clavien-Dindo grade III) was 70 and 24%, respectively. In terms of Comprehensive Complication Index, 34% (261/766) of the patients had ≥26.2. Patients with Comprehensive Complication Index ≥ 26.2 had shorter overall survival (4-year, 59.5 vs. 69.8%, respectively, log-rank test, P = 0.0037) and recurrence free survival (51.9 vs. 60.1%, respectively, P = 0.0234), than those with Comprehensive Complication Index < 26.2. The Cox multivariate model identified the age, performance status, pT-stage, pN-stage and higher CCI (overall survival: HR = 1.35, P = 0.0174, recurrence-free survival: HR = 1.26, P = 0.0443) as independent predictors of both overall survivial and recurrence-free survival. CONCLUSIONS: Postoperative complications assessed by Comprehensive Complication Index had adverse effects on long-term survival outcomes. Physicians should be aware that major postoperative complications can adversely affect long-term disease control.
• 日本語版Body Image Scaleの膀胱癌術後患者における信頼性・妥当性の検証
  樋口 まどか, 佐藤 三穂, 大澤 崇宏, 山田 修平, 宮田 遥, 菊地 央, 松本 隆児, 三浪 圭太, 田中 博, 佐々木 芳浩, 森田 研, 高田 徳容, 原林 透, 古御堂 純, 柏木 明, 村井 祥代, 安部 崇重, 小笠原 克彦, 篠原 信雄
  泌尿器外科, 36, 5, 417, 417, 医学図書出版(株), 2023年05月
  日本語
• 泌尿器科医師が手術時に感じるメンタルワークロードに関する前向き観察研究
  原田 茂, 古御堂 純, 安部 崇重, 高橋 圭太, 今 雅史, 村井 祥代, 菊地 央, 宮田 遥, 松本 隆児, 大澤 崇宏, 篠原 信雄
  泌尿器外科, 36, 5, 427, 427, 医学図書出版(株), 2023年05月
  日本語
• 泌尿器科医師が手術時に感じるメンタルワークロードに関する前向き観察研究(Mental workloads of surgeons in urology: A prospective observational study)　　　　　　　　　　　　　　　
  原田 茂, 古御堂 純, 安部 崇重, 高橋 圭太, 今 雅史, 村井 祥代, 菊地 央, 宮田 遥, 松本 隆児, 大澤 崇宏, 篠原 信雄
  日本泌尿器科学会総会, 110回, AOP12, 07, (一社)日本泌尿器科学会総会事務局, 2023年04月
  英語
• 泌尿器科医師における手術時に感じるメンタルワークロードのクラスター解析について(Cluster analysis of mental workloads of urologists: A prospective observational study)　　　　　　　　　　　　　　　
  古御堂 純, 原田 茂, 安部 崇重, 高橋 圭太, 今 雅史, 宮田 遥, 菊地 央, 松本 隆児, 大澤 崇宏, 村井 祥代, 篠原 信雄
  日本泌尿器科学会総会, 110回, OP10, 03, (一社)日本泌尿器科学会総会事務局, 2023年04月
  英語
• Development and validation of a measurement system for laparoscopic surgical procedures in practical surgery training.
  Koki Ebina, Takashige Abe, Kiyohiko Hotta, Madoka Higuchi, Jun Furumido, Naoya Iwahara, Masafumi Kon, Shunsuke Komizunai, Yo Kurashima, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Teppei Tsujita, Kazuya Sase, XiaoShuai Chen, Nobuo Shinohara, Atsushi Konno
  IEEE/SICE International Symposium on System Integration(SII), 1, 6, IEEE, 2023年
  研究論文（国際会議プロシーディングス）
• Validation of the Japanese version of the Body Image Scale for bladder cancer patients.
  Miho Sato, Takahiro Osawa, Takashige Abe, Michitaka Honda, Madoka Higuchi, Shuhei Yamada, Jun Furumido, Hiroshi Kikuchi, Ryuji Matsumoto, Yasuyuki Sato, Yoshihiro Sasaki, Toru Harabayashi, Satoru Maruyama, Norikata Takada, Keita Minami, Hiroshi Tanaka, Ken Morita, Akira Kashiwagi, Sachiyo Murai, Yoichi M Ito, Katsuhiko Ogasawara, Nobuo Shinohara
  Scientific reports, 12, 1, 21544, 21544, 2022年12月13日, ［国際誌］
  英語, 研究論文（学術雑誌）, The Body Image Scale (BIS) is a 10-item tool that measures the body images of cancer patients. This study aims to validate the Japanese version of the BIS for bladder cancer patients. A multicenter cross-sectional survey was used to identify the participants, which included Japanese bladder cancer patients. The percentage of missing responses, internal consistency, and known-group validity were evaluated. The correlations between the BIS and two HRQOL instruments (the Bladder Cancer Index and the SF-12) were assessed to determine convergent validity. Among 397 patients, 221 patients were treated by transurethral resection of bladder tumor (TURBT) endoscopically, 49 patients underwent cystectomy with neobladder, and 127 patients underwent cystectomy involving stoma. The percentage of missing responses in the BIS ranged from 8.1 to 15.6%. Cronbach's α coefficient was 0.924. Higher BIS scores indicate negative body image, and the median BIS score for patients with native bladders after TURBT (0.5) was significantly lower than those of the patients with neobladder (4.0) and stoma formation (7.0), which indicated the discriminatory ability of the BIS. Each domain of the Bladder Cancer Index and the role summary score of the SF-12 correlated to the BIS scores, which confirmed the convergent validity. A range of BIS scores were identified among patients who reported similar physical summary scores and mental summary scores of the SF-12. This study confirmed the reliability and validity of the Japanese version of the BIS for bladder cancer patients.
• TURBTチェックリスト(CL)を導入前後での治療成績の比較　　　　　　　　　　　　　　　
  大澤 崇宏, 菊地 央, 山田 修平, 宮田 遥, 松本 隆児, 安部 崇重, 村井 祥代, 篠原 信雄
  日本泌尿器内視鏡・ロボティクス学会総会, 36回, O, 7, (一社)日本泌尿器内視鏡・ロボティクス学会, 2022年11月
  日本語
• Incidence of post-transplant hepatitis B virus reactivation with the use of kidneys from donors with resolved hepatitis B virus infection.
  Ren Yamada, Kenichi Morikawa, Kiyohiko Hotta, Daiki Iwami, Tatsu Tanabe, Sachiyo Murai, Nobuo Shinohara, Sonoe Yoshida, Shunichi Hosoda, Akinori Kubo, Yoshimasa Tokuchi, Takashi Kitagataya, Megumi Kimura, Koji Yamamoto, Masato Nakai, Takuya Sho, Goki Suda, Mitsuteru Natsuizaka, Koji Ogawa, Naoya Sakamoto
  Journal of viral hepatitis, 29, 11, 976, 985, 2022年11月, ［国際誌］
  英語, 研究論文（学術雑誌）, Donors with resolved hepatitis B virus (HBV) infection may be a solution for the organ shortage for kidney transplantation (KT). The purpose of this study was to clarify the current state of HBV markers after KT from donors with resolved HBV infection to HBV naïve recipients and the rate of HBV reactivation in recipients with resolved HBV infection. Furthermore, we investigated HBV covalently closed circular DNA (cccDNA) in transplanted organs from donors with resolved HBV infection and the capability of HBV replication in kidney cell lines. We retrospectively analysed the HBV status of 340 consecutive donors and recipients who underwent KT in a single centre. We prospectively measured cccDNA by real-time polymerase chain reaction in kidney biopsy specimens of 32 donors with resolved HBV infection. HBV reactivation was found in three recipients with resolved HBV infection (4.8%, 3/63) after KT. We analysed 45 cases of transplantation from donors with resolved HBV infection to HBV-naive recipients. One case (2.2%, 1/45) became seropositive for hepatitis B core antibody (anti-HBc) and in another case (2.2%, 1/45), HBV-DNA was detected qualitatively in an HBV naive recipient with a donor with resolved HBV infection. In the latter case, cccDNA was measured in the donor kidney during KT. HBV replication was observed in kidney cell lines with HBV plasmid transfection. In conclusion, the risk of reactivation in anti-HBc-positive donors is relatively low. However, post-transplant HBV monitoring should be conducted in all at-risk cases.
• Late recurrence in patients with non-muscle-invasive bladder cancer after 5-year cancer-free periods.
  Yurie Hirata, Madoka Higuchi, Takahiro Osawa, Shiro Hinotsu, Toru Harabayashi, Tango Mochizuki, Nobuyasu Enami, Osamu Nounaka, Yuichiro Shinno, Hiroshi Kikuchi, Ryuji Matsumoto, Takashige Abe, Sachiyo Murai, Nobuo Shinohara
  International journal of urology : official journal of the Japanese Urological Association, 29, 10, 1140, 1146, 2022年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVES: There is no consensus about the follow-up schedule after 5-year cancer-free periods. In this study, we aimed to elucidate the risk factors for the recurrence in patients with non-muscle-invasive bladder cancer who remained cancer free for more than 5 years. METHODS: Data from six Japanese institutions were retrospectively reviewed. Among the patients with non-muscle-invasive bladder cancer who were treated with transurethral resection of bladder tumor between 1990 and 2013, those who had no recurrence for more than 5 years were included in this study. The Kaplan-Meier method and Cox hazards model were used to estimate recurrence-free survival and to determine the pathologic and clinical factors affecting late recurrence. RESULTS: In total, 434 patients were enrolled in this study. Of these patients, 55 patients (12.7%) experienced late recurrence. The median follow-up time was 8.9 years (interquartile range 6.9-11.3 years). Prior history of bladder cancer before the most recent transurethral resection was a significant predictor for late recurrence (hazard ratio 1.99 [95% confidence interval 1.13-3.47], P = 0.019), although other clinical factors including tumor grade, pathologic stage, tumor multiplicity, and current risk classification systems were not associated with late recurrence. CONCLUSIONS: Late recurrence after a long tumor-free period is not rare and it was not predicted by current risk classification systems. Only prior history of bladder cancer was a significant predictor for late recurrence in this study.
• THE DEVELOPMENT OF SKILL EVALUATION SYSTEM FOR LAPAROSCOPIC SURGICAL PROCEDURE
  EBINA KOKI, ABE TAKASHIGE, HOTTA KIYOHIKO, HIGUCHI MADOKA, FURUMIDO JUN, IWAHARA NAOYA, KON MASAFUMI, KOMIZUNAI SHUNSUKE, KURASHIMA YO, KIKUCHI HIROSHI, MATSUMOTO RYUJI, OSAWA TAKAHIRO, MURAI SACHIYO, TSUJITA TEPPEI, SASE KAZUYA, CHEN XIAOSHUAI, SHINOHARA NOBUO, KONNO ATSUSHI
  Proceedings of Jc-IFToMM International Symposium, 5, 73, 79, Japanese Council of IFToMM, 2022年07月16日
  英語, This paper describes details of the development of skill evaluation system for laparoscopic surgical procedure. The measurement experiment was conducted for 70 surgeons, and the participants perform 2 tasks: tissue dissection around the aorta and renal parenchymal suturing/knotting using porcine cadaver. In the experiments, the movement of surgical instruments were recorded by motion capture (MoCap) system, and the motion indices were calculated. The participants grouped into three classes (novices, intermediates, and experts) according to their level of experience. Three classification algorithms: support vector machine (SVM), principal component based SVM (PCA-SVM), gradient boosting decision tree (GBDT) were utilized for developing the model of classifier. The accuracy of each model was assessed by nested and repeated k-fold cross validation. Regarding 3-class classification, the GBDT method resulted highest accuracy (the median of the accuracy is A_med = 68.6 %) in the dissection tasks. In the suturing/knotting tasks, PCA-SVM resulted highest accuracy (A_med = 58.4 %). Regarding 2-class classification (experts vs. intermediates/novices), the GBDT method resulted A_med = 72.9 % in the dissection task, and the PCA-SVM method resulted A_med = 69.2 % in the suturing task. This result shows the MoCap based skill evaluation system in wet-lab training could be a practical way to objectively assess trainees' surgical competence.
• Objective evaluation of laparoscopic surgical skills in wet lab training based on motion analysis and machine learning.
  Koki Ebina, Takashige Abe, Kiyohiko Hotta, Madoka Higuchi, Jun Furumido, Naoya Iwahara, Masafumi Kon, Kou Miyaji, Sayaka Shibuya, Yan Lingbo, Shunsuke Komizunai, Yo Kurashima, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Teppei Tsujita, Kazuya Sase, Xiaoshuai Chen, Atsushi Konno, Nobuo Shinohara
  Langenbeck's archives of surgery, 2022年04月08日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Our aim was to build a skill assessment system, providing objective feedback to trainees based on the motion metrics of laparoscopic surgical instruments. METHODS: Participants performed tissue dissection around the aorta (tissue dissection task) and renal parenchymal closure (parenchymal-suturing task), using swine organs in a box trainer under a motion capture (Mocap) system. Two experts assessed the recorded movies, according to the formula of global operative assessment of laparoscopic skills (GOALS: score range, 5-25), and the mean scores were utilized as objective variables in the regression analyses. The correlations between mean GOALS scores and Mocap metrics were evaluated, and potential Mocap metrics with a Spearman's rank correlation coefficient value exceeding 0.4 were selected for each GOALS item estimation. Four regression algorithms, support vector regression (SVR), principal component analysis (PCA)-SVR, ridge regression, and partial least squares regression, were utilized for automatic GOALS estimation. Model validation was conducted by nested and repeated k-fold cross validation, and the mean absolute error (MAE) was calculated to evaluate the accuracy of each regression model. RESULTS: Forty-five urologic, 9 gastroenterological, and 3 gynecologic surgeons, 4 junior residents, and 9 medical students participated in the training. In both tasks, a positive correlation was observed between the speed-related parameters (e.g., velocity, velocity range, acceleration, jerk) and mean GOALS scores, with a negative correlation between the efficiency-related parameters (e.g., task time, path length, number of opening/closing operations) and mean GOALS scores. Among the 4 algorithms, SVR showed the highest accuracy in the tissue dissection task ([Formula: see text]), and PCA-SVR in the parenchymal-suturing task ([Formula: see text]), based on 100 iterations of the validation process of automatic GOALS estimation. CONCLUSION: We developed a machine learning-based GOALS scoring system in wet lab training, with an error of approximately 1-2 points for the total score, and motion metrics that were explainable to trainees. Our future challenges are the further improvement of onsite GOALS feedback, exploring the educational benefit of our model and building an efficient training program.
• Association of exposure to prenatal perfluoroalkyl substances and estrogen receptor 1 polymorphisms with the second to fourth digit ratio in school-aged children: The Hokkaido study
  Yoko Nishimura, Kimihiko Moriya, Sumitaka Kobayashi, Atsuko Ikeda- Araki, Fumihiro Sata, Takahiko Mitsui, Sachiko Itoh, Chihiro Miyashita, Kazutoshi Cho, Masafumi Kon, Michiko Nakamura, Takeya Kitta, Sachiyo Murai, Reiko Kishi, Nobuo Shinohara
  Reproductive Toxicology, 109, 10, 18, Elsevier BV, 2022年04月
  研究論文（学術雑誌）
• Outcomes of bacillus Calmette-Guérin therapy without a maintenance schedule for high-risk non-muscle-invasive bladder cancer in the second transurethral resection era.
  Hiroshi Kikuchi, Takashige Abe, Ryuji Matsumoto, Takahiro Osawa, Satoru Maruyama, Sachiyo Murai, Nobuo Shinohara
  International journal of urology : official journal of the Japanese Urological Association, 29, 3, 251, 258, 2022年03月, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVES: We examined the outcomes of eight weekly bacillus Calmette-Guérin induction therapy after second transurethral resection, and investigated risk factors for intravesical recurrence or disease progression in high-risk non-muscle-invasive bladder cancer patients. METHODS: This retrospective study included 146 high-risk non-muscle-invasive bladder cancer patients who received eight weekly bacillus Calmette-Guérin instillations without a maintenance schedule between 2000 and 2019. Intravesical recurrence-free and progression-free survival rates were evaluated using the Kaplan-Meier method. The Cox proportional hazards model was used to identify risk factors. RESULTS: Pathological T staging in the first transurethral resection was pTa in 56 patients (38.4%), pT1 in 75 (51.4%) and primary carcinoma in situ in 15 (10.2%). A total of 109 (83.2%) with pTa-1 disease underwent second transurethral resection before bacillus Calmette-Guérin induction therapy, and residual disease was detected in 54 (49.5%). The completion rate of eight instillations was 82.2%. The 2- and 5-year intravesical recurrence-free survival rates were 80.7% and 75.2%, whereas the 2- and 5-year progression-free survival rates were 85.7% and 82.0%. Recurrent tumors (hazard ratio 6.5830, P = 0.0007) and residual tumors at the second transurethral resection (hazard ratio 4.0337, P = 0.0021) were risk factors for intravesical recurrence. Multiple tumors (hazard ratio 5.8056, P = 0.0302), pT1 disease (hazard ratio 3.7351, P = 0.0447) and residual tumors at second transurethral resection (hazard ratio 3.2552, P = 0.0448) were associated with disease progression. CONCLUSIONS: Accurate disease staging and disease elimination by second transurethral resection followed by eight weekly bacillus Calmette-Guérin instillations achieved good disease control. Our protocol (without a maintenance schedule) after thorough surgical resection has potential as a treatment option in the current bacillus Calmette-Guérin shortage.
• Quality improvement in managing patients with non-muscle-invasive bladder cancer by introducing a surgical checklist for transurethral resection of bladder tumor.
  Hiroshi Kikuchi, Takahiro Osawa, Takashige Abe, Ryuji Matsumoto, Satoru Maruyama, Sachiyo Murai, Nobuo Shinohara
  PloS one, 17, 10, e0276816, 2022年, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: The quality of transurethral resection of bladder tumor (TURBT) markedly varies among surgeons and may have a considerable impact on treatment outcomes. The importance of a surgical checklist for TURBT has been suggested in order to standardize the procedure and improve surgical and oncological outcomes. In the present study, we verified the usefulness of a checklist for managing patients with non-muscle-invasive bladder cancer (NMIBC). METHODS: This retrospective study included 201 NMIBC patients diagnosed with Ta, T1, or Tis between October 2011 and February 2021. After September 2016, TURBT was performed with a checklist. We analyzed the intravesical recurrence-free survival (RFS) rate and the presence or absence of the detrusor muscle in resected specimens before and after the introduction of the checklist. Survival rates were compared using the Log-rank test. A multivariate analysis with Cox proportional hazards modeling was performed to verify risk factors for intravesical recurrence. RESULTS: Ninety-nine patients who underwent TURBT with the checklist (checklist group) were compared with 102 patients who underwent TURBT without the checklist (non-checklist group). When the analysis was narrowed down to 9 critical items, we observed a mean number of 9 documented items per operative report (98.0% completion) after implementation of the checklist. Two-year intravesical RFS rates in the checklist and non-checklist groups were 76.7 and 69.5%, respectively (p = 0.1059). The Cox proportional multivariate analysis showed that the rate of intravesical recurrence was slightly lower in the checklist group (hazard ratio 0.7376, 95% CI 0.4064-1.3388, P = 0.3170). CONCLUSION: The introduction of a checklist is recommended for the standardization of TURBT and increasing the quality of operative reporting, and it may also improve oncological outcomes.
• Automatic assessment of laparoscopic surgical skill competence based on motion metrics.
  Koki Ebina, Takashige Abe, Kiyohiko Hotta, Madoka Higuchi, Jun Furumido, Naoya Iwahara, Masafumi Kon, Kou Miyaji, Sayaka Shibuya, Yan Lingbo, Shunsuke Komizunai, Yo Kurashima, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Teppei Tsujita, Kazuya Sase, Xiaoshuai Chen, Atsushi Konno, Nobuo Shinohara
  PloS one, 17, 11, e0277105, 2022年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, The purpose of this study was to characterize the motion features of surgical devices associated with laparoscopic surgical competency and build an automatic skill-credential system in porcine cadaver organ simulation training. Participants performed tissue dissection around the aorta, dividing vascular pedicles after applying Hem-o-lok (tissue dissection task) and parenchymal closure of the kidney (suturing task). Movements of surgical devices were tracked by a motion capture (Mocap) system, and Mocap-metrics were compared according to the level of surgical experience (experts: ≥50 laparoscopic surgeries, intermediates: 10-49, novices: 0-9), using the Kruskal-Wallis test and principal component analysis (PCA). Three machine-learning algorithms: support vector machine (SVM), PCA-SVM, and gradient boosting decision tree (GBDT), were utilized for discrimination of the surgical experience level. The accuracy of each model was evaluated by nested and repeated k-fold cross-validation. A total of 32 experts, 18 intermediates, and 20 novices participated in the present study. PCA revealed that efficiency-related metrics (e.g., path length) significantly contributed to PC 1 in both tasks. Regarding PC 2, speed-related metrics (e.g., velocity, acceleration, jerk) of right-hand devices largely contributed to the tissue dissection task, while those of left-hand devices did in the suturing task. Regarding the three-group discrimination, in the tissue dissection task, the GBDT method was superior to the other methods (median accuracy: 68.6%). In the suturing task, SVM and PCA-SVM methods were superior to the GBDT method (57.4 and 58.4%, respectively). Regarding the two-group discrimination (experts vs. intermediates/novices), the GBDT method resulted in a median accuracy of 72.9% in the tissue dissection task, and, in the suturing task, the PCA-SVM method resulted in a median accuracy of 69.2%. Overall, the mocap-based credential system using machine-learning classifiers provides a correct judgment rate of around 70% (two-group discrimination). Together with motion analysis and wet-lab training, simulation training could be a practical method for objectively assessing the surgical competence of trainees.
• Validation of an online application to identify potential immune-related adverse events associated with immune checkpoint inhibitors based on the patient's symptoms.
  Takahiro Osawa, Takashige Abe, Hiroshi Kikuchi, Ryuji Matsumoto, Sachiyo Murai, Takafumi Nakao, Shinji Tanaka, Ayu Watanabe, Nobuo Shinohara
  PloS one, 17, 3, e0265230, 2022年, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Immune checkpoint inhibitors (ICIs) are increasingly being used to treat malignancies. Some patients experience immune-related adverse events (irAEs), which may affect any organ/tissue. IrAEs are occasionally fatal and usually have nonspecific symptoms. We developed a three-step application (https://irae-search.com/) to provide healthcare professionals with information on the diagnosis, treatment options, and published reports for 38 categories of irAEs encountered in clinical practice. METHODS: IrAEs reported in ≥5 cases were identified from articles published between October 2018 and August 2020 by searching Japanese (SELIMIC, JAPIC-Q Service, and JMED Plus) and international (MEDLINE, EMBASE, Derwent Drug File) databases. The cases' symptoms were entered into the application to identify irAEs, which were verified using the reported diagnosis, to evaluate the application's sensitivity and specificity. RESULTS: Overall, 1209 cases (1067 reports) were analyzed. The three most common categories of irAEs were pituitary or adrenal disorders (14% of cases), skin disorders (13%), and diabetes mellitus (10%). The top three primary diseases were lung cancer (364 cases), melanoma (286 cases), and renal cell carcinoma (218 cases). The average sensitivity was 90.8% (range 44.4%-100.0%) initially, and improved to 94.8% (range 83.3%-100.0%) after incorporating the symptoms reported in published cases into the application's logic for two irAE categories. The average specificity was 79.3% (range 59.1% [thyroid disorders]-98.2% [arthritis]). CONCLUSION: irAE Search is an easy-to-use application designed to help healthcare professionals identify potential irAEs in ICI-treated patients in a timely manner to facilitate prompt management/treatment. The application showed high sensitivity and moderate-to-high specificity for detecting irAEs.
• Efficacy of nivolumab plus ipilimumab as first-line therapy for primary tumors in patients with renal cell carcinoma.
  Hiroshi Kikuchi, Takahiro Osawa, Ryuji Matsumoto, Takashige Abe, Satoru Maruyama, Toru Harabayashi, Haruka Miyata, Akira Kashiwagi, Suguru Ikeshiro, Ataru Sazawa, Riyo Fukui, Ken Morita, Ichiro Takeuchi, Kanta Hori, Noboru Yamashita, Keita Minami, Tango Mochizuki, Sachiyo Murai, Nobuo Shinohara
  Urologic oncology, 40, 1, 13.e19-13.e27, 2022年01月, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVES: With the emergence of several effective combination therapies, information on their effects at the primary site will be crucial for planning future cytoreductive nephrectomy (CN). The present study focused exclusively on changes in primary tumor sizes following treatment with nivolumab plus ipilimumab and investigated the clinical factors associated with a good response in primary tumors. METHODS AND MATERIALS: We retrospectively assessed 27 patients diagnosed with advanced renal cell carcinoma (RCC) who started treatment with nivolumab plus ipilimumab. Changes in tumor sizes at the primary site were described using waterfall and spider plots, respectively. We analyzed the correlation of tumor shrinkage between primary and metastatic site. The parameters analyzed between responders and non-responders according to primary tumor sizes were International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk scores, peripheral blood markers, and CRP. RESULTS: The median age and follow-up period were 66 years and 9.3 months, respectively. The median IMDC risk score was 3 (range: 1-6). Nineteen patients were diagnosed with clear-cell RCC (ccRCC) and 8 patients with non-ccRCC. Among ccRCC patients, 9 (47.4%) achieved a significant response with a maximum reduction of 30% or more in the size of the primary tumor from baseline within 4 months, while 3 (37.5%) out of 8 patients with non-ccRCC achieved a significant response. Shrinkage of the primary tumor correlated with the metastatic tumors in both ccRCC and non-ccRCC cases. Of note, 6 patients underwent CN and no viable tumor cells were detected in the surgical specimens of 3 patients whose primary tumors shrank by approximately 50%-60% with a reduction to 4 cm or less. Among ccRCC patients, the neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio were slightly lower in responders than in non-responders (P = 0.0944 and P = 0.0691). The platelet-to-lymphocyte ratio was significantly lower in responders than in non-responder (P = 0.0391). CONCLUSIONS: Significant responses in primary tumors to nivolumab plus ipilimumab were observed in 50% of ccRCC patients, while responses varied among non-ccRCC patients. Inflammation markers may be predictive factors of treatment responses in primary tumors. Although further studies are needed, the present results suggest the importance of considering CN from radiological and pathological viewpoints.
• Novel double-filtration plasmapheresis preserves fibrinogen while removing immunoglobulin-G antibodies before ABO blood type-incompatible kidney transplantation
  Daiki Iwami, Takenao Matsumoto, Kota Ono, Kiyohiko Hotta, Minoru Ota, Yuki Chiba, Hajime Sasaki, Takayuki Hirose, Haruka Higuchi, Yusuke Takada, Naoya Iwahara, Sachiyo Murai, Nobuo Shinohara
  Renal Replacement Therapy, 7, 1, 2021年12月
  研究論文（学術雑誌）
• アキシチニブを投与した転移性腎細胞癌の腫瘍学的成績と予後因子の多施設共同コホート研究による解析(Oncologic outcome and prognostic factor analysis in a multi-center cohort treated with axitinib for metastatic renal cell carcinoma)　　　　　　　　　　　　　　　
  大澤 崇宏, 小島 崇宏, 武内 在雄, 杉元 幹史, 江藤 正俊, 三浪 圭太, 中井 康友, 植田 浩介, 伊藤 陽一, 村井 祥代, 北村 寛, 西山 博之, 篠原 信雄
  日本泌尿器科学会総会, 109回, ISP01, 03, (一社)日本泌尿器科学会総会事務局, 2021年12月
  英語
• Spontaneous closure of arteriovenous fistula after kidney transplantation.
  Tatsu Tanabe, Kiyohiko Hotta, Naoya Iwahara, Daiki Iwami, Sachiyo Murai, Nobuo Shinohara
  International journal of urology : official journal of the Japanese Urological Association, 28, 8, 872, 873, 2021年08月, ［国際誌］
  英語, 研究論文（学術雑誌）
• ウエットラボにおける腹腔鏡手術熟練課程の数値化の試み　　　　　　　　　　　　　　　
  安部 崇重, 海老名 光希, 樋口 まどか, 古御堂 純, 岩原 直也, 今 雅史, 堀田 紀世彦, 小水内 俊介, 倉島 庸, 村井 祥代, 近野 敦, 篠原 信雄
  泌尿器外科, 34, 3, 327, 327, 医学図書出版(株), 2021年03月
  日本語
• ロボット支援腹腔鏡下前立腺全摘除術における神経温存が健康関連QOLに及ぼす影響　　　　　　　　　　　　　　　
  大澤 崇宏, 安部 崇重, 松本 隆児, 菊地 央, 山田 修平, 古御堂 純, 宮田 遥, 村井 祥代, 伊藤 陽一, 篠原 信雄
  泌尿器外科, 34, 3, 321, 321, 医学図書出版(株), 2021年03月
  日本語
• 筋層非浸潤性膀胱癌のTUR後晩期再発に関する検討　　　　　　　　　　　　　　　
  平田 由里絵, 大澤 崇宏, 樋口 まどか, 樋之津 史郎, 原林 透, 望月 端吾, 榎並 宣裕, 能中 修, 信野 祐一郎, 菊地 央, 松本 隆児, 安部 崇重, 村井 祥代, 篠原 信雄
  泌尿器外科, 34, 3, 331, 331, 医学図書出版(株), 2021年03月
  日本語
• Comparison of Health-Related Quality of Life Between Japanese and American Patients with Bladder Cancer as Measured by a Newly Developed Japanese Version of the Bladder Cancer Index
  Takahiro Osawa, John T. Wei, Takashige Abe, Michitaka Honda, Karl T. Rew, Rod Dunn, Shuhei Yamada, Jun Furumido, Hiroshi Kikuchi, Ryuji Matsumoto, Yasuyuki Sato, Toni Harabayashi, Norikata Takada, Keita Minami, Ken Morita, Akira Kashiwagi, Shunichi Fukuhara, Sachiyo Murai, Yoichi M. Ito, Katsuhiko Ogasawara, Nobuo Shinohara
  BLADDER CANCER, 7, 1, 61, 69, 2021年
  英語, 研究論文（学術雑誌）
• モーションキャプチャー装置を用いた腹腔鏡手術手技の熟練過程の分析　　　　　　　　　　　　　　　
  安部 崇重, 海老名 光希, 樋口 まどか, 古御堂 純, 岩原 直也, 今 雅史, 堀田 記世彦, 小水内 俊介, 倉島 庸, 村井 祥代, 近野 敦, 篠原 信雄
  日本泌尿器科学会総会, 108回, 899, 899, (一社)日本泌尿器科学会総会事務局, 2020年12月
  日本語
• Efficacy and safety of second-line axitinib in octogenarians with metastatic renal cell carcinoma
  Yasutomo Nakai, Ario Takeuchi, Takahiro Osawa, Takahiro Kojima, Tomohiko Hara, Mikio Sugimoto, Masatoshi Eto, Keita Minami, Kosuke Ueda, Michinobu Ozawa, Motohide Uemura, Yasuyuki Miyauchi, Kojiro Ohba, Akira Kashiwagi, Masaya Murakami, Tomokazu Sazuka, Hiroaki Yasumoto, Shuichi Morizane, Yoshihide Kawasaki, Daichi Morooka, Toru Shimazui, Yoshiaki Yamamoto, Hiroshi Nakagomi, Ryotaro Tomida, Yoichi M. Ito, Sachiyo Murai, Hiroshi Kitamura, Hiroyuki Nishiyama, Nobuo Shinohara
  Journal of Geriatric Oncology, Elsevier BV, 2020年12月
  研究論文（学術雑誌）
• Health-related quality of life in Japanese patients with bladder cancer measured by a newly developed Japanese version of the Bladder Cancer Index.
  Takahiro Osawa, John T Wei, Takashige Abe, Michitaka Honda, Shuhei Yamada, Jun Furumido, Hiroshi Kikuchi, Ryuji Matsumoto, Kazushi Hirakawa, Yasuyuki Sato, Yoshihiro Sasaki, Toru Harabayashi, Norikata Takada, Keita Minami, Hiroshi Tanaka, Ken Morita, Akira Kashiwagi, Naoto Miyajima, Tomoshige Akino, Sachiyo Murai, Yoichi M Ito, Shunichi Fukuhara, Katsuhiko Ogasawara, Nobuo Shinohara
  International journal of clinical oncology, 25, 12, 2090, 2098, 2020年12月, ［国内誌］
  英語, 研究論文（学術雑誌）, INTRODUCTION: We validated a Japanese version of the Bladder Cancer Index (BCI) as a tool for measuring health-related quality of life (HRQOL) in bladder cancer patients treated with various surgical procedures. METHODS: The reliability and validity of the Japanese BCI were examined in 397 Japanese patients with bladder cancer via cross-sectional analysis. The patients simultaneously completed the Short Form (SF)-12, EQ-5D, and the Functional Assessment of Cancer Therapy-General and Bladder (FACT-G and FACT-BL). The differences in BCI subscales among various treatment groups were analyzed. RESULTS: This study involved 397 patients (301 males and 96 females), with a mean age of 70 years and a median disease duration of 29 months (IQR: 12-66 months). Of these patients, 221 underwent transurethral resection of a bladder tumor, and 176 patients underwent radical cystectomy (ileal conduit: 101 patients, ileal neobladder: 49, and ureterostomy: 26). Cronbach's alpha coefficient was ≥ 0.78 for all subscales, except the bowel bother subscale. Despite moderate correlations being detected between the function and bother score in urinary and bowel domains, the sexual function score was inversely correlated with the sexual bother score (r = - 0.19). A missing value percentage of > 15% was associated with old age (p < 0.05). The mean domain scores differed significantly among distinct clinically relevant treatment groups. CONCLUSIONS: Although revisions are needed to make it easier for elderly patients to comprehend, we confirmed the reliability and validity of the Japanese BCI. The Japanese BCI could be used for cross-cultural assessments of HRQOL in bladder cancer patients.
• Motion analysis for better understanding of psychomotor skills in laparoscopy: objective assessment-based simulation training using animal organs
  Koki Ebina, Takashige Abe, Madoka Higuchi, Jun Furumido, Naoya Iwahara, Masafumi Kon, Kiyohiko Hotta, Shunsuke Komizunai, Yo Kurashima, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Teppei Tsujita, Kazuya Sase, Xiaoshuai Chen, Atsushi Konno, Nobuo Shinohara
  SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2020年09月
  英語, 研究論文（学術雑誌）
• Development and validation of a porcine organ model for training in essential laparoscopic surgical skills.
  Madoka Higuchi, Takashige Abe, Kiyohiko Hotta, Ken Morita, Haruka Miyata, Jun Furumido, Naoya Iwahara, Masafumi Kon, Takahiro Osawa, Ryuji Matsumoto, Hiroshi Kikuchi, Yo Kurashima, Sachiyo Murai, Abdullatif Aydin, Nicholas Raison, Kamran Ahmed, Muhammad Shamim Khan, Prokar Dasgupta, Nobuo Shinohara
  International journal of urology : official journal of the Japanese Urological Association, 2020年08月03日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVES: To develop a wet laboratory training model for learning core laparoscopic surgical skills and evaluating learners' competency level outside the operating room. METHODS: Participants completed three tasks (task 1: tissue dissection around the aorta; task 2: tissue dissection and division of the renal artery; task 3: renal parenchymal closure). Each performance was video recorded and subsequently evaluated by two experts, according to the Global Operative Assessment of Laparoscopic Skills and task-specific metrics that we developed (Assessment Sheet of Laparoscopic Skills in Wet Lab score). Mean scores were used for analyses. The subjective mental workload was also assessed (NASA Task Load Index). RESULTS: The 54 participants included 32 urologists, eight young trainees and 14 medical students. A total of 13 participants were categorized as experts (≥50 laparoscopic surgeries), eight as intermediates (10-49) and 33 as novices (0-9). There were significant differences in the Global Operative Assessment of Laparoscopic Skills and Assessment Sheet of Laparoscopic Skills in Wet Lab scores among the three groups in all three tasks. Higher NASA Task Load Index scores were observed in novices, and there were significant differences in tasks 1 (Kruskal-Wallis test, P = 0.0004) and 2 (P = 0.0002), and marginal differences in task 3 (P = 0.0745) among the three groups. CONCLUSIONS: Our training model has good construct validity, and differences in the NASA Task Load Index score reflect previous laparoscopic surgical experiences. Our findings show the ability to assess both laparoscopic surgical skills and mental workloads, which could help educators comprehend trainees' level outside the operating room. Given the decreasing opportunity to carry out pure laparoscopic surgeries because of the dissemination of robotic surgery, especially in urology, our model can offer practical training opportunities.
• Erratum: Prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients receiving systemic chemotherapy.
  Takashige Abe, Keita Minami, Toru Harabayashi, Ataru Sazawa, Hiroki Chiba, Hiroshi Kikuchi, Haruka Miyata, Jun Frumido, Ryuji Matsumoto, Takahiro Osawa, Ishizaki Junji, Mochizuki Tango, Chiba Satoshi, Akino Tomoshige, Murakumo Masashi, Miyajima Naoto, Tsuchiya Kunihiko, Maruyama Satoru, Sachiyo Murai, Nobuo Shinohara
  Japanese journal of clinical oncology, 50, 6, 727, 727, 2020年06月10日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）
• Oncological outcomes of a multi-center cohort treated with axitinib for metastatic renal cell carcinoma.
  Takahiro Osawa, Takahiro Kojima, Tomohiko Hara, Mikio Sugimoto, Masatoshi Eto, Ario Takeuchi, Keita Minami, Yasutomo Nakai, Kosuke Ueda, Michinobu Ozawa, Motohide Uemura, Yasuyuki Miyauchi, Kojiro Ohba, Toshiro Suzuki, Satoshi Anai, Tetsuya Shindo, Naohisa Kusakabe, Keita Tamura, Motokiyo Komiyama, Takayuki Goto, Akira Yokomizo, Naoki Kohei, Akira Kashiwagi, Masaya Murakami, Tomokazu Sazuka, Hiroaki Yasumoto, Hideto Iwamoto, Koji Mitsuzuka, Daichi Morooka, Toru Shimazui, Yoshiaki Yamamoto, Suguru Ikeshiro, Hiroshi Nakagomi, Ken Morita, Ryotaro Tomida, Tango Mochizuki, Takamitsu Inoue, Hiroshi Kitamura, Shuhei Yamada, Y M Ito, Sachiyo Murai, Hiroyuki Nishiyama, Nobuo Shinohara, Haruhiko Fukuda
  Cancer science, 2020年05月13日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, The present study aimed to evaluate the efficacy of the real-world use of axitinib and to develop a prognostic model for stratifying patients who could derive long-term benefit from axitinib. This was a retrospective, descriptive study evaluating the efficacy of axitinib in patients with metastatic renal cell carcinoma that had been treated with one or two systemic anti-angiogenic therapy regimens at one of 36 hospitals belonging to the Japan Urologic Oncology Group between January 2012 and February 2019. The primary outcome was overall survival (OS). Using a split-sample method, candidate variables that exhibited significant relationships with OS were chosen to create a model. The new model was validated using the rest of the cohort. In total, 485 patients were enrolled. The median OS was 34 months in the entire study population, whereas it was not reached, 27 months, and 14 months in the favorable, intermediate, and poor risk groups, respectively, according to the new risk classification model. The following four variables were included in the final risk model: the disease stage at diagnosis, number of metastatic sites at the start of axitinib therapy, serum albumin level, and neutrophil:lymphocyte ratio. The adjusted area under the curve values of the new model at 12, 36, and 60 months were 0.77, 0.82, and 0.82, respectively. The efficacy of axitinib in routine practice is comparable or even superior to that reported previously. The patients in the new model's favorable risk group might derive a long-term survival benefit from axitinib treatment.
• Association of exposure to prenatal phthalate esters and bisphenol A and polymorphisms in the ESR1 gene with the second to fourth digit ratio in school-aged children: Data from the Hokkaido study.
  Yoko Nishimura, Kimihiko Moriya, Sumitaka Kobayashi, Atsuko Araki, Fumihiro Sata, Takahiko Mitsui, Sachiko Itoh, Chihiro Miyashita, Kazutoshi Cho, Masafumi Kon, Michiko Nakamura, Takeya Kitta, Sachiyo Murai, Reiko Kishi, Nobuo Shinohara
  Steroids, 159, 108637, 108637, 2020年03月09日, ［査読有り］, ［国際誌］
  英語, Phthalates and bisphenol A (BPA) are estrogenic endocrine disruptors. Polymorphisms in the gene encoding estrogen receptor 1 (ESR1) may contribute to the ratio of the lengths of the second and fourth digits (2D:4D), which is considered an index of prenatal exposure to sex hormones. Thus, we investigated whether ESR1 polymorphisms modify the effects of prenatal exposure to phthalates and BPA on 2D:4D in a birth cohort. Maternal serum in the first trimester was used to determine prenatal exposure to these compounds. Six hundred twenty-three children (7 years of age) provided mean 2D:4D from photocopies and were genotyped for single nucleotide polymorphisms in ESR1, particularly PvuII (T > C, dbSNP: rs2234693), XbaI (A > G, dbSNP: rs9340799), and rs2077647 (A > G). The associations among compound exposure, mean 2D:4D, and ESR1 polymorphisms were assessed by multiple linear regression adjusted for potential cofounding factors. Boys with the AG/GG genotype at rs2077647 in the group exposed to high levels of mono(2-ethylhexyl) phthalate (MEHP) or Σ Di(2-ethylhexyl) phthalate (DEHP) showed feminized 2D:4D compared with boys with the AA genotype at rs2077647 who had low exposure to MEHP or ΣDEHP (MEHP: increase in mean 2D:4D of 1.51%, 95% confidence interval [CI]: 0.40-2.63; ΣDEHP: increase in mean 2D:4D of 1.37%, 95% CI: 0.25-2.49). No significant differences were found among girls. There were no associations between mean 2D:4D and metabolites other than MEHP or BPA. These data suggest that ESR1 polymorphisms modify the effects of prenatal exposure to DEHP on mean 2D:4D among boys.
• Validity assessment of the laparoscopic radical nephrectomy module of the LapVision virtual reality simulator.
  Haruka Miyata, Takashige Abe, Kiyohiko Hotta, Madoka Higuchi, Takahiro Osawa, Ryuji Matsumoto, Hiroshi Kikuchi, Yo Kurashima, Sachiyo Murai, Nobuo Shinohara
  Surgery open science, 2, 1, 51, 56, 2020年01月, ［国際誌］
  英語, 研究論文（学術雑誌）, Background: Virtual reality simulators allow trainees to perform repeated practice and provide objective dexterity metrics regarding their performance, which means that virtual reality-based surgical training is becoming a vital part of initial learning of basic laparoscopic surgical skills. However, its educational role in learning advanced procedures remains undetermined. We evaluated the validity of the laparoscopic radical nephrectomy module of the LapVision virtual reality simulator. Methods: Urologists, medical students, and a junior resident voluntarily participated in the present study, and they performed training with a laparoscopic left radical nephrectomy module. For construct validation, dexterity metrics calculated in the simulator and the mean score of Global Operative Assessment of Laparoscopic Skills evaluated by 2 experts' video review were compared according to the certification of Japanese Endoscopic Surgical Skill Qualification or previous surgical experience. Results: Ten experts (≥ 50 laparoscopic surgeries), 9 intermediates (11-49), and 14 novices (0-10) voluntarily participated in the present study. Regarding the construct validity, there was a significant difference in the total number of errors, blood loss, and Global Operative Assessment of Laparoscopic Skills score among the groups for both the Endoscopic Surgical Skill Qualification status and previous surgical experience. Conclusion: The present study demonstrated good construct validity for the LapVision nephrectomy module. Furthermore, global skill assessment was possible by experts' reviews, which indicates the usefulness of the virtual reality procedural module as a skill assessment tool. Virtual reality-based procedural simulation has marked potential to become a vital part of integrated laparoscopic training programs.
• 腸管利用尿路変向を行った開腹膀胱全摘除術における術前因子を用いた周術期重度合併症予測ノモグラムの作成の試み
  山田 修平, 大澤 崇宏, 安部 崇重, 高田 徳容, 松本 隆児, 伊藤 陽一, 菊地 央, 宮島 直人, 土屋 邦彦, 丸山 覚, 村井 祥代, 篠原 信雄
  泌尿器科紀要, 65, 12, 495, 499, 泌尿器科紀要刊行会, 2019年12月, ［査読有り］
  日本語, 1997〜2010年までの間に20施設で膀胱癌に対して腸管利用尿路変向の開腹膀胱全摘除術(開腹RC)を施行した668例(男性528例、女性140例、年齢中央値65歳)を対象に、周術期重度合併症の術前予測因子を検討した。その結果、男性、心血管疾患既往、同時NUx(同時腎尿管全摘除術)が周術期重度合併症の有意な予測因子となったものの、この3つの因子を用いたモノグラムではAUC 0.58と十分な予測精度を持つには至らなかった。
• [The Development of the Preoperative Nomogram Predicting Major Perioperative Complications after Radical Cystectomy with Ileal Conduit or Orthotopic Neobladder].
  Shuhei Yamada, Takahiro Osawa, Takashige Abe, Norikata Takada, Ryuji Matsumoto, YoichiM Ito, Hiroshi Kikuchi, Naoto Miyajima, Kunihiko Tsuchiya, Satoru Maruyama, Sachiyo Murai, Nobuo Shinohara
  Hinyokika kiyo. Acta urologica Japonica, 65, 12, 495, 499, 2019年12月, ［査読有り］, ［国内誌］
  日本語, Radical cystectomy (RC) is the gold standard for managing muscle-invasive and high-risknon-muscleinvasive bladder cancer, but is accompanied by non-negligible operative risk. The aim of this study is to identify preoperative variables to predict major perioperative complications after RC and to develop a nomogram using the cohort from multiple institutions in Japan. We retrospectively reviewed 668 patients who underwent open RC with ileal conduit or neobladder at Hokkaido University hospital and 20 affiliated institutions between 1997 and 2010. Complications occurring within 90 days of surgery were graded using modified Clavien classification system. We defined modified Clavien grade 3 or more as major complications and performed univariate and multivariate logistic regression analyses. Predictive accuracy of the nomogram was evaluated with the area under the receiver operating characteristics curve (AUC). A total of 528 men and 140 women were included in this study. There were a total of 160/668 patients (24%) with major perioperative complications. A multivariate model identified gender (OR : 1. 63, p=0. 04), cardiovascular comorbidity (OR : 1.48, p=0.03) and simultaneous nephroureterectomy (OR : 2.81, p=0. 01) as independent predictors. Using these 3 variables, a nomogram was developed with the AUC of 0.58. Predictive performance of our nomogram showed only fair performance ; but at least, we identified male, cardiovascular comorbidity and simultaneous nephroureterectomy as independent predictors of perioperative major complications.
• ロボット支援腹腔鏡下前立腺全摘除術における神経温存が健康関連QOLに及ぼす影響　　　　　　　　　　　　　　　
  大澤 崇宏, 安部 崇重, 松本 隆児, 菊地 央, 山田 修平, 古御堂 純, 宮田 遥, 村井 祥代, 伊藤 陽一, 篠原 信雄
  日本泌尿器内視鏡学会総会, 33回, O, 2, (一社)日本泌尿器内視鏡・ロボティクス学会, 2019年11月
  日本語
• ロボット支援腹腔鏡下前立腺全摘除術における神経温存が健康関連QOLに及ぼす影響　　　　　　　　　　　　　　　
  大澤 崇宏, 安部 崇重, 松本 隆児, 菊地 央, 山田 修平, 古御堂 純, 宮田 遥, 村井 祥代, 伊藤 陽一, 篠原 信雄
  日本泌尿器内視鏡学会総会, 33回, O, 2, (一社)日本泌尿器内視鏡・ロボティクス学会, 2019年11月
  日本語
• Prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients receiving systemic chemotherapy.
  Abe T, Minami K, Harabayashi T, Sazawa A, Chiba H, Kikuchi H, Miyata H, Frumido J, Matsumoto R, Osawa T, Junji I, Tango M, Satoshi C, Tomoshige A, Masashi M, Naoto M, Kunihiko T, Satoru M, Murai S, Shinohara N
  Japanese journal of clinical oncology, 2019年10月28日, ［査読有り］, ［国際誌］
  英語, OBJECTIVE: To clarify the prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients treated by systemic chemotherapy. METHODS: Of the 228 metastatic urothelial carcinoma patients treated with systemic chemotherapy, 97 received radiotherapy mainly to metastatic sites. In patients for whom the purpose of radiotherapy was not specified, more than 50 Gy irradiation was considered to be for disease consolidation for survival analysis, while less than 50 Gy was categorized as palliation. According to the Kaplan-Meier method, we analysed overall survival from the initiation of treatment for metastatic urothelial carcinoma until death or the last follow-up, using the log-rank test to assess the significance of differences. The Cox model was applied for prognostic factor analysis. RESULTS: Overall, there was no significant difference in survival between patients with and those without radiotherapy (P = 0.1532). When analysing the patients undergoing consolidative radiotherapy separately, these 25 patients showed significantly longer survival than the 72 patients with palliative radiotherapy (P = 0.0047), with a 3-year overall survival of 43.3%. Of the present cohort, 22 underwent metastasectomy for disease consolidation, and there was no overlapping case between the metastasectomy cohort and cohort receiving consolidative radiotherapy. After controlling for four independent prognostic factors (sex, performance status, haemoglobin level and number of organs with metastasis) in our previous study, radiotherapy for disease consolidation showed a marginal value (hazard ratio = 0.666, P = 0.0966), while metastasectomy remained significant (hazard ratio = 0.358, P = 0.0006). CONCLUSIONS: In the selected patients, long-term disease control could be achieved after consolidative radiotherapy for metastatic urothelial carcinoma disease. Our observations suggest that local ablative therapy (surgery or radiotherapy) could facilitate long-term disease control. However, the treatment decision should be individualized because of the lack of randomized control trials.
• Development of the Japanese version of the health-related quality of life questionnaire for bladder cancer patients using the Bladder Cancer Index: A pilot study.
  Osawa T, Wei JT, Abe T, Kako Y, Murai S, Shinohara N
  International journal of urology : official journal of the Japanese Urological Association, 2019年07月, ［査読有り］
• Nephrometry score correlated with tumor proliferative activity inT1 clear cell renal cell carcinoma.
  Kikuchi H, Abe T, Matsumoto R, Osawa T, Maruyama S, Murai S, Shinohara N
  Urologic oncology, 37, 5, 301.e19-301.e25, 301.e25, 2019年05月, ［査読有り］, ［国際誌］
  英語, OBJECTIVE: To evaluate the association between the RENAL nephrometry score (RNS) and tumor proliferative activity assessed by immunohistochemistry in patients with localized renal cell carcinoma. METHODS: The current study included 145 pathological T1 (pT1) clear cell renal cell carcinomas (ccRCC). Tumor proliferative activity was assessed with the Ki67 index and microvessel density (MVD). RNS was retrospectively assessed in the present study. We divided patients into 3 groups according to RNS (RNS 4-6: low-complexity, 7-9: moderate complexity, and 10-12: high-complexity tumors) and compared the Ki67 index as well as MVD among the 3 groups. The association between the Ki67index/MVD and each component (R, E, N, A, L, h) was also evaluated. RESULTS: There were 56 low, 84 moderate, and 5 high-complexity tumors. The median Ki67 index of all tumors was 5.34% (interquartile range: 3.28-8.57). The median Ki67 index of low, moderate, and high-complexity tumors was 3.97%, 6.39%, and 11.27%, respectively, with a significant difference among the 3 groups (Kruskal-Wallis test, P = 0.0004). On the other hand, the median MVD of low, moderate, and high-complexity tumors was 14.11%, 14.42%, and 21.22%, respectively, and there were no significant differences among the 3 groups. In terms of each RNS component, there were significant differences in the Ki67 index among the 3 groups in N (P = 0.0101) and L (P = 0.0280) components, respectively. CONCLUSIONS: The revealed association between RNS and the Ki67 index in pT1 clear cell renal cell carcinomas further supports the previous findings that the anatomy of renal cell carcinoma is associated with the malignant potential of localized clear cell renal cell carcinoma, which may provide additional information for treatment decision.
• Association between ESR1 polymorphisms and second to fourth digit ratio in school-aged children in the Hokkaido Study.
  Nishimura Y, Moriya K, Kobayashi S, Araki A, Sata F, Mitsui T, Itoh S, Miyashita C, Cho K, Kon M, Nakamura M, Kitta T, Murai S, Kishi R, Shinohara N
  Steroids, 141, 55, 62, 2019年01月, ［査読有り］
• Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection.
  Takashige Abe, Tsunenori Kondo, Toru Harabayashi, Norikata Takada, Ryuji Matsumoto, Takahiro Osawa, Keita Minami, Satoshi Nagamori, Satoru Maruyama, Sachiyo Murai, Kazunari Tanabe, Nobuo Shinohara
  Japanese journal of clinical oncology, 48, 11, 1001, 1011, 2018年11月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, Objective: To assess the number of lymph nodes removed as a surrogate marker of the extent of lymph node dissection, and compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in patients undergoing standardized lymph node dissection. Methods: We retrospectively analyzed the data of 214 cTanyN0M0 patients undergoing radical NU with regional lymph node dissection according to the tumor location. The Kaplan-Meier method and Cox hazards model were utilized for survival analyses, including recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Results: A total of 114 patients underwent LRNU and 100 underwent ORNU. There was no significant difference in the pT stage, pN stage, or tumor grade, but distal ureteral tumors were more frequent in the LRNU group. The number of lymph nodes removed did not differ between the two groups [LRNU: 12 (median), ORNU: 11.5, P = 0.3852]. Lymph node metastasis was pathologically identified in 19 patients (8.9%). The 5-year RFS (ORNU: 71.7%, LRNU: 74%, P = 0.7829), CSS (77.8 and, 80%, P = 0.8441) and OS (72.8, and 75.9%, P = 0.3456) did not differ between the two groups. In the sub-analysis of pT3/4 patients (n = 83), there were no significant differences in RFS, CSS, or OS between the two groups, although Kaplan-Meier survival curves were slightly better for those receiving ORNU. In the multivariate model, LRNU was not significantly correlated with a poorer RFS, CSS or OS. Conclusion: Our data support the feasibility of lymph node dissection with a laparoscopic approach and the equivalent oncological outcome of LRNU compared with ORNU when regional lymph node dissection is performed. However, LRNU should be performed after careful patient selection for advanced disease.
• Thiel法献体における尿管鏡カダバートレーニングの初期経験 ドライボックスとの比較　　　　　　　　　　　　　　　
  今 雅史, 安部 崇重, 石川 修平, 大澤 崇宏, 松本 隆児, 菊地 央, 七戸 俊明, 村井 祥代, 篠原 信雄
  日本泌尿器内視鏡学会総会, 32回, O, 1, (一社)日本泌尿器内視鏡・ロボティクス学会, 2018年11月
  日本語
• バーチャルリアリティーシミュレーター腹腔鏡下腎摘除術の妥当性の検証　　　　　　　　　　　　　　　
  宮田 遥, 安部 崇重, 樋口 まどか, 堀田 記世彦, 大澤 崇宏, 松本 隆児, 菊地 央, 倉島 庸, 村井 祥代, 篠原 信雄
  日本泌尿器内視鏡学会総会, 32回, DP, 5, (一社)日本泌尿器内視鏡・ロボティクス学会, 2018年11月
  日本語
• cT1腎癌に対する開腹腎部分切除術と鏡視下腎部分切除術後のSF-36を用いたQOLの比較　　　　　　　　　　　　　　　
  大澤 崇宏, 安部 崇重, 菊地 央, 松本 隆児, 宮島 直人, 土屋 邦彦, 丸山 覚, 伊藤 陽一, 村井 祥代, 篠原 信雄
  日本泌尿器内視鏡学会総会, 32回, P, 10, (一社)日本泌尿器内視鏡・ロボティクス学会, 2018年11月
  日本語
• Thiel法献体における尿管鏡カダバートレーニングの初期経験 ドライボックスとの比較　　　　　　　　　　　　　　　
  今 雅史, 安部 崇重, 石川 修平, 大澤 崇宏, 松本 隆児, 菊地 央, 七戸 俊明, 村井 祥代, 篠原 信雄
  日本泌尿器内視鏡学会総会, 32回, O, 1, (一社)日本泌尿器内視鏡・ロボティクス学会, 2018年11月
  日本語
• バーチャルリアリティーシミュレーター腹腔鏡下腎摘除術の妥当性の検証　　　　　　　　　　　　　　　
  宮田 遥, 安部 崇重, 樋口 まどか, 堀田 記世彦, 大澤 崇宏, 松本 隆児, 菊地 央, 倉島 庸, 村井 祥代, 篠原 信雄
  日本泌尿器内視鏡学会総会, 32回, DP, 5, (一社)日本泌尿器内視鏡・ロボティクス学会, 2018年11月
  日本語
• cT1腎癌に対する開腹腎部分切除術と鏡視下腎部分切除術後のSF-36を用いたQOLの比較　　　　　　　　　　　　　　　
  大澤 崇宏, 安部 崇重, 菊地 央, 松本 隆児, 宮島 直人, 土屋 邦彦, 丸山 覚, 伊藤 陽一, 村井 祥代, 篠原 信雄
  日本泌尿器内視鏡学会総会, 32回, P, 10, (一社)日本泌尿器内視鏡・ロボティクス学会, 2018年11月
  日本語
• Outcome and prognostic factors in metastatic urothelial carcinoma patients receiving second-line chemotherapy: an analysis of real-world clinical practice data in Japan.
  Ryuji Matsumoto, Takashige Abe, Junji Ishizaki, Hiroshi Kikuchi, Toru Harabayashi, Keita Minami, Ataru Sazawa, Tango Mochizuki, Tomoshige Akino, Masashi Murakumo, Takahiro Osawa, Satoru Maruyama, Sachiyo Murai, Nobuo Shinohara
  Japanese journal of clinical oncology, 48, 8, 771, 776, 2018年08月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, Objectives: The objective of the present study was to investigate the survival outcome and prognostic factors of metastatic urothelial carcinoma patients treated with second-line systemic chemotherapy in real-world clinical practice. Methods: Overall, 114 patients with metastatic urothelial carcinoma undergoing second-line systemic chemotherapy were included in this retrospective analysis. The dominant second-line chemotherapy was a paclitaxel-based combination regimen (60%, 68/114). We assessed the progression-free survival and overall survival times using the Kaplan-Meier method. The Cox proportional hazards model was applied to identify the factors affecting overall survival. Results: The median progression-free survival and overall survival times were 4 and 9 months, respectively. In the multivariate analysis, an Eastern Cooperative Oncology Group performance status score greater than 0 at presentation, C-reactive protein level ≧1 mg/dl and poor response to prior chemotherapy were adverse prognostic indicators. Patients with 0, 1, 2 and 3 of those risk factors had a median overall survival of 17, 12, 7 and 3 months, respectively. Conclusions: The Eastern Cooperative Oncology Group performance status at presentation, C-reactive protein level and response to prior chemotherapy were prognostic factors for metastatic urothelial carcinoma patients undergoing second-line chemotherapy. In the future, this information might help guide the choice of salvage treatment, such as second-line chemotherapy or immune checkpoint inhibitors, after the failure of first-line chemotherapy.
• Validation of the nomogram for predicting 90-day mortality after radical cystectomy in a Japanese cohort.
  Osawa T, Abe T, Takada N, Ito YM, Murai S, Shinohara N
  International journal of urology : official journal of the Japanese Urological Association, 25, 7, 699, 700, 2018年07月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）
• THE MODIFIED GLASGOW PROGNOSTIC SCORE IS A POWERFUL PROGNOSTIC FACTOR IN METASTATIC UROTHELIAL CARCINOMA PATIENTS RECEIVING SECOND-LINE CHEMOTHERAPY
  Matsumoto Ryuji, Abe Takashige, Ishizaki Junji, Minami Keita, Harabayashi Toru, Sazawa Ataru, Mochizuki Tango, Akino Tomoshige, Murakumo Masashi, Miyajima Naoto, Tsuchiya Kunihiko, Kikuchi Hiroshi, Miyata Haruka, Osawa Takahiro, Maruyama Satoru, Murai Sachiyo, Shinohara Nobuo
  JOURNAL OF UROLOGY, 199, 4, E1045, 2018年04月, ［査読有り］
• OUTCOME OF MAINTENANCE SYSTEMIC CHEMOTHERAPY WITH DRUG-FREE INTERVAL FOR METASTATIC UROTHELIAL CARCINOMA
  Abe Takashige, Ishizaki Junji, Minami Keita, Harabayashi Toru, Sazawa Ataru, Mochizuki Tango, Chiba Satoshi, Chiba Hiroki, Akino Tomoshige, Murakumo Masashi, Miyajima Naoto, Tsuchiya Kunihiko, Kikuchi Hiroshi, Miyata Haruka, Matsumoto Ryuji, Osawa Takahiro, Maruyama Satoru, Murai Sachiyo, Shinohara Nobuo
  JOURNAL OF UROLOGY, 199, 4, E1042, 2018年04月, ［査読有り］
• Characteristics of Medical Adverse Events/Near Misses Associated With Laparoscopic/Thoracoscopic Surgery: A Retrospective Study Based on the Japanese National Database of Medical Adverse Events.
  Abe T, Murai S, Nasuhara Y, Shinohara N
  Journal of patient safety, 15, 4, 343, 351, 2017年09月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVES: The aim of this study was to clarify the characteristics of adverse events/near misses during laparoscopic/thoracoscopic surgery. METHODS: Using relevant key words for minimally invasive surgeries, 540 records were identified in the database of the Japan Council for Quality Health Care. After data review and the classification of adverse events, 746 events associated with laparoscopic (laparo group) and/or thoracoscopic (thoraco group) surgery were identified. We calculated the frequency of each event, compared the frequency regarding recurrent events, and evaluated the types of event that had resulted in deaths between the 2 groups. RESULTS: There were 582 events in the laparo group, 159 in the thoraco group, and 5 in those undergoing combined surgery. Overall, injury of other organs (11.4%, 85/746), retention of a foreign body (9.1%, 68/746), breakage/failure of medical equipment or devices (6.2%, 46/746), massive bleeding (5.9%, 44/746), misperception of anatomy (5.6%, 42/746), and vascular injury (4.8%, 36/746) were frequently reported. There were marked differences in the frequency of injury of other organs (laparo group: 13.4%, 78/582; thoraco group: 4.4%, 7/159), massive bleeding (laparo group: 3.4%, 20/582; thoraco group: 14.5%, 23/159), and vascular injury (laparo group: 2.6%, 15/582; thoraco group: 12.6%, 20/159) between the 2 groups. Among the 56 patient-death reports, 132 adverse events were identified. In the thoraco group, bleeding events were frequently observed, whereas in the laparo group, various categories of events were noted. CONCLUSIONS: We observed recurrent incidents and differences in the frequency between the 2 groups. Surgeons should keep in mind these characteristics. Retention of a foreign body and the breakage/malfunctioning of instruments might be reduced by the introduction of specialized checklists.
• Perioperative morbidity and mortality of octogenarians treated by radical cystectomy-a multi-institutional retrospective study in Japan.
  Takashige Abe, Norikata Takada, Hiroshi Kikuchi, Ryuji Matsumoto, Takahiro Osawa, Sachiyo Murai, Naoto Miyajima, Satoru Maruyama, Nobuo Shinohara
  Japanese journal of clinical oncology, 47, 8, 755, 761, 2017年08月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, Objective: To determine the characteristics of 90-day morbidity and mortality after radical cystectomy in Japanese octogenarians. Methods: A retrospective multi-institutional study. We reviewed the records of 834 patients treated by open radical cystectomy between 1997 and 2010. All complications within 90 days after surgery were sorted into the 11 categories proposed by the Memorial Sloan-Kettering Cancer Center and graded according to the modified Clavien-Dindo system. We compared the characteristics of complications between ≥80-year (n = 86) and <80-year (n = 748) groups. Multivariate regression models were used to determine the predictors of complications. Results: American Society of Anesthesiologists score III-IV was more frequent (14% vs. 6%, respectively, P < 0.0001), and ureterocutaneostomy was more frequently performed (30% vs. 21%, respectively, P = 0.0148) in the ≥80-year group compared with <80-year group. There were no significant differences in the rates of any complication, major (Grade 3-5) complication, or 90-day mortality between the two groups (≥80-year group: 70%, 21%, 3.5%, respectively, <80-year group: 68%, 22%, 2%, respectively). The ≥80-year group had fewer genitourinary complications (7% vs. 16%, respectively, P = 0.0131). Multivariate regression analyses revealed that bowel-using urinary diversion (P = 0.0031) and the operative time (P = 0.0269) were significant predictors of any grade of complications, and a male sex (P = 0.0167), annual cystectomy volume (P = 0.0284) and prior cardiovascular comorbidity (P = 0.0034) were significant predictors of major complications. Conclusions: In our experience, radical cystectomy in Japanese octogenarians caused similar perioperative comorbidities. Old age as a single criterion should not be used to abandon radical cystectomy; careful preoperative assessment is mandatory.
• 膀胱全摘患者における術前因子および周術期因子が周術期死亡や合併症に与える影響 国際多施設研究
  大澤 崇宏, 安部 崇重, 高田 徳容, 宮島 直人, 土屋 邦彦, 丸山 覚, 村井 祥代, Lee Cheryl T., Morgan Todd M., 篠原 信雄
  泌尿器外科, 30, 7, 1197, 1197, 医学図書出版(株), 2017年07月
  日本語
• 日本人および米国人患者に対する膀胱全摘除術後周術期死亡予測ノモグラムの外的妥当性の検証
  大澤 崇宏, 安部 崇重, 高田 徳容, 伊藤 陽一, 菊地 央, 宮島 直人, 土屋 邦彦, 丸山 覚, Lee Cheryl T., Morgan Todd M., 村井 祥代, 篠原 信雄
  泌尿器外科, 30, 7, 1207, 1207, 医学図書出版(株), 2017年07月
  日本語
• 日本人および米国人患者に対する膀胱全摘除術後周術期死亡予測ノモグラムの外的妥当性の検証　　　　　　　　　　　　　　　
  大澤 崇宏, 安部 崇重, 高田 徳容, 伊藤 陽一, 菊地 央, 宮島 直人, 土屋 邦彦, 丸山 覚, 村井 祥代, りー・しぇりる, もるがん・とっど, 篠原 信雄
  日本泌尿器科学会総会, 105回, OP14, 3, (一社)日本泌尿器科学会総会事務局, 2017年04月
  日本語
• 腸管利用尿路変更膀胱全摘除術における術前因子と周術期重度合併症の関連　　　　　　　　　　　　　　　
  山田 修平, 大澤 崇宏, 安部 崇重, 高田 徳容, 伊藤 陽一, 菊池 央, 宮島 直人, 丸山 覚, 土屋 邦彦, 村井 祥代, 篠原 信雄
  日本泌尿器科学会総会, 105回, PP11, 08, (一社)日本泌尿器科学会総会事務局, 2017年04月
  日本語
• COMPARATIVE STUDY OF ONCOLOGICAL OUTCOMES OF LAPAROSCOPIC AND OPEN RADICAL NEPHROURETERECTOMY FOR PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT UNDERGOING REGIONAL LYMPH NODE DISSECTION
  Abe Takashige, Kondo Tsunenori, Harabayashi Toru, Takada Norikata, Matsumoto Ryuji, Sazawa Ataru, Osawa Takahiro, Minami Keita, Nagamori Satoshi, Miyajima Naoto, Tsuchiya Kunihiko, Maruyama Satoru, Murai Sachiyo, Tanabe Kazunari, Shinohara Nobuo
  JOURNAL OF UROLOGY, 197, 4, E952, 2017年04月, ［査読有り］
• Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan.
  Takashige Abe, Junji Ishizaki, Hiroshi Kikuchi, Keita Minami, Ryuji Matsumoto, Toru Harabayashi, Ataru Sazawa, Tango Mochizuki, Satoshi Chiba, Tomoshige Akino, Masashi Murakumo, Naoto Miyajima, Kunihiko Tsuchiya, Satoru Maruyama, Sachiyo Murai, Nobuo Shinohara
  Urologic oncology, 35, 2, 38.e1-38.e8, 38.e8, 2017年02月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, AIM: To clarify prognostic factors of metatstatic urothelial carcinoma treated by systemic chemotherapy in real-world clinical practice in the Japanese population. MATERIALS AND METHODS: A total of 228 patients with metastatic urothelial carcinoma undergoing systemic chemotherapy between 2000 and 2013 were included in the present multi-institutional study. The gemcitabine plus cisplatin regimen was administered as first-line chemotherapy to 131 patients, whereas methotrexate, vinblastine, doxorubicin, and cisplatin or its modified regimen was given to 71 patients. Of the 228 patients, 119 received at least 2 different regimens and 22 underwent resection of metastases (metastasectomy). Multivariate survival analysis was performed using the Cox proportional hazards model. The characteristics included were age, sex, Eastern Cooperative Oncology Group performance status (PS), primary site, pathology of primary site, hemoglobin levels, lactate dehydrogenase levels, C-reactive protein levels, corrected calcium levels, estimated glomerular filtration rate levels, history of prior chemotherapy, metastatic sites, resection of primary site, number of metastatic organs, and metastasectomy. RESULTS: The median overall survival (OS) time was 17 months. On multivariate analysis, female sex, good Eastern Cooperative Oncology Group PS at presentation, hemoglobin level≥10g/dl, and single organ metastasis were significant independent predictors of prolonged OS. For the survival effect of metastasectomy, the median OS time of the 22 patients with metastasectomy was 53 months, which was significantly longer when compared with patients not undergoing metastasectomy (15mo). After adjustment for the 4 aforementioned prognostic factors, metastasectomy still remained significant (hazard ratio: 0.364, P = 0.0008). CONCLUSIONS: Female sex, more favorable PS at presentation, hemoglobin level>10g/dl, and single organ metastasis were favorable prognostic factors. In addition, metastasectomy was associated with long-term disease control.
• A Multi-Center International Study Assessing the Impact of Differences in Baseline Characteristics and Perioperative Care Following Radical Cystectomy.
  Osawa T, Lee CT, Abe T, Takada N, Hafez KS, Montgomery JS, Weizer AZ, Hollenbeck BK, Skolarus TA, Murai S, Shinohara N, Morgan TM
  Bladder cancer (Amsterdam, Netherlands), 2, 2, 251, 261, 2016年04月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, Background: To identify potential avenues for quality improvement, we compared the variations in clinical practice and their association with perioperative morbidity and mortality following radical cystectomy (RC) for bladder cancer in the United States (US) and Japan. Methods: We reviewed our retrospectively collected database of 2240 patients who underwent RC for bladder cancer at the University of Michigan (n = 1427) and in 21 Japanese institutions (n = 813) between 1997 and 2014. We performed a systematic comparison of clinical and perioperative factors and assessed predictors of perioperative morbidity and mortality. Death within 90 days of surgery was the primary outcome. Results: There were apparent differences between the two study populations. Notably, US patients had a significantly greater BMI and higher ASA score. In Japanese institutions, median postoperative hospital stay was significantly higher (40 days vs. 7 days, p <  0.001) and 90-day readmission rates were significantly lower (0.6% vs. 26.8% , p <  0.001). There was a total of 1372/2240 (61.2%) patients with complications within 90 days and 66/2240 (2.9%) patient deaths. Significant predictors of 90-day mortality were older age (OR 1.04, CI 1.01-1.07), higher body mass index (OR 1.07, CI 1.02-1.12), node-positive disease (OR 3.14, CI 1.78-5.47), increased blood loss (OR 1.02, CI 1.01-1.03), and major (Clavien-grade 3 or greater) complication (OR 3.29, CI 1.88-5.71). Conclusion: Despite major differences in baseline characteristics and care of cystectomy patients between the two study populations, peri-operative mortality rates proved to be comparable. This data supports an exploration of non-traditional factors that may influence mortality after cystectomy.
• Five-point Likert scaling on MRI predicts clinically significant prostate carcinoma.
  Taisuke Harada, Takashige Abe, Fumi Kato, Ryuji Matsumoto, Hiromi Fujita, Sachiyo Murai, Naoto Miyajima, Kunihiko Tsuchiya, Satoru Maruyama, Kohsuke Kudo, Nobuo Shinohara
  BMC urology, 15, 91, 91, 2015年09月04日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: To clarify the relationship between the probability of prostate cancer scaled using a 5-point Likert system and the biological characteristics of corresponding tumor foci. METHODS: The present study involved 44 patients undergoing 3.0-Tesla multiparametric MRI before laparoscopic radical prostatectomy. Tracing based on pathological and MRI findings was performed. The relationship between the probability of cancer scaled using the 5-point Likert system and the biological characteristics of corresponding tumor foci was evaluated. RESULTS: A total of 102 tumor foci were identified histologically from the 44 specimens. Of the 102 tumors, 55 were assigned a score based on MRI findings (score 1: n = 3; score 2: n = 3; score 3: n = 16; score 4: n = 11 score 5: n = 22), while 47 were not pointed out on MRI. The tracing study revealed that the proportion of >0.5 cm(3) tumors increased according to the upgrade of Likert scores (score 1 or 2: 33%; score 3: 68.8%; score 4 or 5: 90.9%, χ(2) test, p < 0.0001). The proportion with a Gleason score >7 also increased from scale 2 to scale 5 (scale 2: 0%; scale 3: 56.3%; scale 4: 72.7%; 5: 90.9%, χ(2) test, p = 0.0001). On using score 3 or higher as the threshold of cancer detection on MRI, the detection rate markedly improved if the tumor volume exceeded 0.5 cm(3) (<0.2 cm(3): 10.3%; 0.2-0.5 cm(3): 25%; 0.5-1.0 cm(3): 66.7%; 1.0 < cm(3): 92.1%). CONCLUSIONS: Each Likert scale favobably reflected the corresponding tumor's volume and Gleason score. Our observations show that "score 3 or higher" could be a useful threshold to predict clinically significant carcinoma when considering treatment options.
• Prospective mapping of lymph node metastasis in Japanese patients undergoing radical cystectomy for bladder cancer: characteristics of micrometastasis.
  Ryuji Matsumoto, Norikata Takada, Takashige Abe, Keita Minami, Toru Harabayashi, Satoshi Nagamori, Kanako C Hatanaka, Naoto Miyajima, Kunihiko Tsuchiya, Satoru Maruyama, Sachiyo Murai, Nobuo Shinohara
  Japanese journal of clinical oncology, 45, 9, 874, 80, 2015年09月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: To investigate node-disease prevalence including micrometastases and its survival impact on bladder cancer patients. METHODS: A total of 60 patients participated in this study, in which extended lymph node dissection was carried out according to the prospective rule (below aortic bifurcation). Radical cystectomy and extended lymph node dissection were performed by open surgery (n = 23) or laparoscopically (n = 37). Perioperative, pathological and follow-up data were collected. Micrometastasis in lymph nodes was investigated by pan-cytokeratin immunohistochemistry. Recurrence-free survival was estimated with the Kaplan-Meier method. RESULTS: The median number of lymph nodes removed was 29 (range: 10-103) and there was no significant difference between the two groups (open group: median 30, laparoscopic group: median 29). Routine pathological examination revealed that 10 patients had lymph node metastases. Immunohistochemistry revealed micrometastases in four additional patients (pNmicro+), who had been diagnosed with pN0 on routine pathological examination. After excluding the three patients with pure nonurothelial carcinoma on the final pathology (small cell carcinoma: n = 2, adenocarcinoma: n = 1), 10 out of the 57 urothelial carcinoma patients (17.5%) had node metastasis, and an additional 4 out of the 47 pN0 patients (4/47, 8.5%) had micrometastasis. The 2-year recurrence-free survival rates divided by pN stage were 82.4% for pN0, 66.7% for pNmicro+ and 12.5% for pN+ (three-sample log-rank test, P < 0.0001). Three out of the four patients with pNmicro+ were disease free at the last follow-up. CONCLUSIONS: We confirmed under extended lymph node dissection that a substantial proportion of the patients had node metastasis (pN+: n = 10 and pNmicro+: n = 4), and the pN stage influenced patient survival. Our observations of micrometastasis yielded additional evidence for the potential survival benefit of extended lymphadenectomy by eliminating microdisease.
• Diagnostic outcome of ureteroscopy in urothelial carcinoma of the upper urinary tract: Incidence of later cancer detection and its risk factors after the first examination
  Norihiro Murahashi, Takashige Abe, Nobuo Shinohara, Sachiyo Murai, Toru Harabayashi, Ataru Sazawa, Satoru Maruyama, Kunihiko Tsuchiya, Naoto Miyajima, Kanako Hatanaka, Katsuya Nonomura
  BMC UROLOGY, 15, 92, 2015年09月, ［査読有り］
  英語, 研究論文（学術雑誌）
• Prognosis of Japanese patients with previously untreated metastatic renal cell carcinoma in the era of molecular-targeted therapy.
  Nobuo Shinohara, Wataru Obara, Katsunori Tatsugami, Sei Naito, Tomomi Kamba, Masayuki Takahashi, Sachiyo Murai, Takashige Abe, Koji Oba, Seiji Naito
  Cancer science, 106, 5, 618, 26, 2015年05月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, A multicenter cooperative study was conducted to clarify the prognosis of Japanese patients with metastatic renal cell carcinoma in the era of molecular-targeted therapy and the clinical usefulness of the Japanese metastatic renal cancer (JMRC) prognostic classification. Of 389 consecutive patients for whom treatment was started between 2008 and 2010 at 23 hospitals in Japan, 357 patients who received vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) or cytokine as initial systemic therapy were the subject of the present study. Patients were classified into three prognostic groups according to the JMRC prognostic classification. The endpoints were progression-free survival (PFS) and overall survival (OS) after the start of the initial treatment. The median PFS and OS for the entire cohort of 357 patients were 9.1 and 27.2 months, respectively. VEGFR-TKI were selected for patients with multiple organ metastases, those with liver metastasis, and those with bone metastasis. The median PFS and OS were 11.0 and 23.2 months and 5.4 and 38.2 months in the VEGFR-TKI group and the cytokines group, respectively. The JMRC prognostic classification was useful as a prognostic model for PFS and OS (c-indexes: 0.613 and 0.630 in patients who initially received VEGFR-TKI and 0.647 and 0.642 in patients who received cytokines, respectively). The present study showed for the first time the prognosis of Japanese patients with metastatic renal cell carcinoma in the era of molecular-targeted therapy. The JMRC prognostic classification may be clinically useful as a prognostic model.
• Comparison of 90-day complications between ileal conduit and neobladder reconstruction after radical cystectomy: a retrospective multi-institutional study in Japan.
  Takashige Abe, Norikata Takada, Nobuo Shinohara, Ryuji Matsumoto, Sachiyo Murai, Ataru Sazawa, Satoru Maruyama, Kunihiko Tsuchiya, Shino Kanzaki, Katsuya Nonomura
  International journal of urology : official journal of the Japanese Urological Association, 21, 6, 554, 9, 2014年06月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: To determine the differences in the type, incidence, and severity of 90-day morbidity after radical cystectomy between two different methods of urinary diversion, ileal conduit and neobladder. METHODS: We carried out a retrospective multi-institutional study by reviewing the records of 668 patients treated with open radical cystectomy, and ileal conduit (n = 493) or neobladder substitution (n = 175) between 1997 and 2010. All complications within 90 days after surgery were divided into 11 specific categories as reported by the Memorial-Sloan Kettering Cancer Center, and graded according to the modified Clavien system. Type, incidence and severity of the 90-day morbidity between the two different types of urinary diversions were compared. RESULTS: There was no significant difference in the overall complication rates between the two groups (ileal conduit: 72% [353/493], neobladder: 74% [129/175], P = 0.5909), whereas the neobladder group had fewer major (grade 3 or more) complications (13 vs 20%, respectively, P = 0.0271). The neobladder group had more infectious complications (43 vs 31%, respectively, P = 0.0037), mainly as a result of urinary tract infection, whereas the ileal conduit group had more wound-related complications (24 vs 14%, respectively, P = 0.0068), mainly as a result of surgical site infection. The 90-day mortality rates were 1.1% (2/175) in the neobladder group and 1.6% (8/493) in the ileal conduit group (P = 0.6441). CONCLUSIONS: There was no significant difference in the overall complication rates between the two methods, and patients with neobladder had fewer major complications. The neobladder group had more infectious complications, whereas the ileal conduit group had more wound-related complications.
• RENAL nephrometry score is a predictive factor for the annual growth rate of renal mass.
  Ryuji Matsumoto, Takashige Abe, Nobuo Shinohara, Sachiyo Murai, Satoru Maruyama, Kunihiko Tsuchiya, Katsuya Nonomura
  International journal of urology : official journal of the Japanese Urological Association, 21, 6, 549, 52, 2014年06月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: To evaluate the association between the RENAL nephrometry score and annual growth rates of renal masses presumed to be renal cell carcinoma. METHODS: The current study included 47 renal tumors followed up for at least 12 months, of which 26 tumors were found to be pathologically proven renal cell carcinomas. Annual tumor growth rates were calculated from changes in the maximal diameter on computed tomography, and RENAL nephrometry scores were recorded on initial imaging by two senior urologists. The associations between clinical characteristics including the RENAL nephrometry score and annual growth rates were analyzed using a linear regression model. RESULTS: The median tumor size at diagnosis was 1.7 cm (range 0.6-5.8). The median nephrometry score at diagnosis was 7 (range 4-10). Overall, the median tumor growth rate was 0.34 cm per year (range -0.19-2.0). Linear regression analysis showed that the annual tumor growth rate was associated with the RENAL nephrometry score (P < 0.0001), but it was independent of the age at diagnosis, sex and initial tumor size. In addition, the correlation between the RENAL nephrometry score and annual growth rate remained significant in the 26 pathologically proven renal cell carcinomas. CONCLUSIONS: The RENAL nephrometry score is associated with the annual growth rate of renal masses. Our findings further support the association between the RENAL nephrometry score and tumor biology.
• Outcome of Metastasectomy for Urothelial Carcinoma: A Multi-Institutional Retrospective Study in Japan
  Takashige Abe, Hiroshi Kitamura, Wataru Obara, Nagahide Matsumura, Taiji Tsukamoto, Tomoaki Fujioka, Isao Hara, Sachiyo Murai, Nobuo Shinohara, Katsuya Nonomura
  JOURNAL OF UROLOGY, 191, 4, 932, 936, 2014年04月, ［査読有り］
  英語, 研究論文（学術雑誌）