External validation of nomograms for prediction of progression-free survival and liver toxicity in patients with advanced renal cell carcinoma treated with pazopanib.

BACKGROUND: Nomograms have been developed for the prediction of progression-free survival (PFS) and liver toxicity in patients with advanced renal cell carcinoma (RCC) who are treated with pazopanib. The objectives of this study were to review clinical outcomes, to perform an external validation of these nomograms and to develop a new nomogram in Japanese patients. METHODS: A retrospective chart review of 150 Japanese patients with advanced RCC who received pazopanib at Kobe University Hospital and affiliated hospitals from March 2014 to June 2017 was performed. We evaluated the clinical efficacy and safety of pazopanib using logistic regression analysis to analyze the prognostic factors for overall survival (OS) and PFS. For nomogram validation, concordance index (C-index) and calibration were used. RESULTS: The median PFS and OS in this study was 13.1 and 37.4 months, respectively. Multivariate analyses identified prognostic factors for OS (number of metastasis, white blood cell (WBC) count and lactate dehydrogenase) and PFS (number of metastasis, WBC count). The C-index of nomograms for 12-month PFS was 0.598. The C-index of nomograms for liver toxicity was 0.558. A new Nomogram for predicting 12-month PFS for patients who received pazopanib was developed and performed internal validation. The C-index of the nomogram was 0.768. CONCLUSION: The clinical effect and safety of pazopanib reported in this study was similar to previous studies. This study suggests careful application of nomograms to Japanese patients treated with pazopanib. We have developed a new nomogram for predicting 12-month PFS with pazopanib therapy from Japanese patients.

[Angiography: clinical evaluation and physical characteristics of FPD - the clinical impact caused by detector characteristics].

We have been engaged in clinical work using DSA, the first in the world, under a joint study agreement with Hitachi Medical Corporation on the use of the Flat Panel Detector (FPD) since 2001. We are now in the stage where a certain evaluation process has been finished, but the FPD performance study in angiography has just begun, and, therefore, its clinical evaluation results are very few. Therefore, we studied the relativity between clinical images and physical characteristics in order to examine the characteristics of FPD by referencing them to clinical images. We did an evaluation of the clinical images to which their physical characteristics such as granularity, resolution, contrast, etc., are reflected by comparing FPD and I.I. images.

[A questionnaire survey on the theory of postoperative infection prophylaxis in urologic surgery].

The implementation of the Japanese guidelines for prevention of postoperative infection in urological surgery, based on the Centers for Disease Control and Prevention (CDC) was surveyed. In October 2006, questionnaires about selection of prophylactic antibiotics, timing and period of administration, were distributed to 25 urologists. Surgical procedures were classified into four categories by contamination levels: 1. clean surgery, 2. clean-contaminated surgery, 3. contaminated surgery (surgery with urinary tract diversion using the intestine), and 4. laparoscopic surgery. Implementation of recommendations was about 70% in the selection of prophylactic antibiotics, and 20-30% for the timing of administration in four categories. Adequate implementation was low for the timing of administration. Period of administration in contaminated surgery was longest in all categories. Concerning the administration period and the selection of antibiotics for contaminated surgery, marked differences from recommendations were seen. Therefore further education in hospitals in Japan is needed.

Oncologic Outcome of Radical Prostatectomy as Monotherapy for Men with High-risk Prostate Cancer.

BACKGROUND: The objective of this study was to review our experience with radical prostatectomy (RP) as monotherapy for men with high-risk prostate cancer (PCa). PATIENTS AND METHODS: This study included 382 consecutive patients who were diagnosed with high-risk PCa according to the D'Amico definition and subsequently underwent RP without neoadjuvant therapy. Biochemical recurrence (BR) was defined as a serum prostate-specific antigen (PSA) level ≥ 0.2 ng/ml on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached ≥ 0.4 ng/ml. RESULTS: The median preoperative serum PSA level in these 382 patients was 15.9 ng/ml. Pathological stages ≥ pT2c and Gleason scores ≥ 8 were observed in 288 and 194 patients, respectively. During the observation period (median, 48.0 months), BR occurred in 134 patients, and the 5-year BR-free survival rate was 60.1%; however, no patient died of cancer progression. Multivariate analysis identified capsular invasion, seminal vesicle invasion, and surgical margin status as independent predictors of BR. CONCLUSIONS: Comparatively favorable cancer control could be achieved using RP as monotherapy for men with high-risk PCa; however, RP alone may be insufficient for patients with capsular invasion, seminal vesicle invasion, and/or surgical margin positivity.

[Experience in IVR performed using a posture support device designed especially for a patient unable to take the decubitus position].

We were requested to perform IVR for uterine artery embolotherapy of a patient who was unable to take the decubitus position. Because of extreme overweight, the patient was limited to a sitting posture on a bed in the living environment. Therefore, a device to support her sitting posture on the IVR patient table was designed and created. The support device was used to hold the patient's body in a half-sitting posture and distribute her weight load appropriately so that the weight load applied to the patient's body could be minimized. Using this support device, IVR could be performed smoothly during a period of 2 hours 40 minutes.

Oncological Outcomes in Japanese Men Undergoing Orchiectomy for Stage I Testicular Germ Cell Tumor.

BACKGROUND: The objective of this study was to retrospectively review oncological outcomes in patients with stage I testicular germ cell tumor (GCT). PATIENTS AND METHODS: This study included 265 consecutive Japanese men undergoing orchiectomy for stage I testicular GCT, and a retrospective review of their records was performed. RESULTS: Of these 265 patients, 192 and 73 were pathologically classified with seminoma and nonseminoma, respectively. Prophylactic radiation and chemotherapy were performed in 62 patients with seminoma and 6 with nonseminoma, respectively. Disease recurrence occurred in 12 seminoma patients, of whom 11 had not received prophylactic radiation therapy; however, all 12 achieved a complete response to bleomycin, etoposide and cisplatin therapy. Of the nonseminoma patients, 19 experienced disease recurrence and were then treated with bleomycin, etoposide and cisplatin followed additionally by the surgical resection of residual tumors and salvage chemotherapy in 7 and 4, respectively. There was no cancer-specific death in the 265 patients, and 5-year recurrence-free survival rates in patients with seminoma and nonseminoma were 92.6 and 72.8%, respectively. Furthermore, following factors appeared to be significantly associated with recurrence-free survival in these patients: age, T classification, microvascular invasion and adjuvant therapy for those with seminoma, and microvascular invasion for those with nonseminoma. CONCLUSIONS: Despite a generally favorable prognosis in Japanese men with stage I testicular GCT, intensive follow-up or prophylactic therapy should be considered for men with possible risk factors of disease recurrence.

[Clinical study with angiography system using a flat panel detecter].

We have been using an X-ray angiography system that incorporates a flat panel detector (FPD) since December 2001. This system is equipped with the scintillator-type FPD PaxScan 4030A from Varian Medical Systems, and for objective comparison of the image intensifier (I.I.) and FPD, the system is constructed so that these detectors can be used alternatively. Using this system and other X-ray angiography systems, visual studies have been conducted on the digital subtraction angiography (DSA) images acquired by FPD and I.I. We have found from the clinical images that the FPD is superior to the I.I. in depiction of fine blood vessels as well as of physical characteristics. Fluoroscopy images acquired by the FPD were not entirely satisfactory, however the improvement made in its performance now permits equal use of the FPD and I.I. systems.

[Newly developed monitor for IVR: liquid crystal display (LCD) replaced with cathode ray tube (CRT)].

For physicians who monitor images during interventional radiology (VR), we have built and been using a system that employs a liquid crystal display (LCD) instead of the conventional cathode ray tube (CRT). The system incorporates a ceiling-suspension-type monitor (three-display monitor) with an LCD on each of the three displays for the head and abdominal regions and another ceiling-suspension-type monitor (5-display monitor) with an LCD on each display for the cardiac region. As these monitors are made to be thin and light in weight, they can be placed in a high position in the room, thereby saving space and allowing for more effective use of space in the X-ray room. The system has also improved the efficiency of operators in the IVR room. The three-display folding mechanism allows the displays to be viewed from multiple directions, thereby improving the environment so that the performance of IVR can be observed.

Candida albicans endophthalmitis after extracorporeal shock wave lithotripsy in a patient with liver cirrhosis.

A 69-year-old man was referred to our hospital because of hepatic failure after extracorporeal shock wave lithotripsy. The diagnosis of urinary tract infection and fungemia due to Candida albicans associated with decompensated liver cirrhosis and renal failure was made. Bilateral endogenous endophthalmitis developed during hospitalization. Candidemia, endophthalmitis and hepatorenal failure improved with intensive therapy. After discharge, endophthalmitis of the left eye relapsed and vitrectomy was performed. Clinicians should be aware that fungemia complicated by endophthalmitis can be caused by extracorporeal shock wave lithotripsy. There might be a risk of such complications among patients with liver cirrhosis in an immunocompromised state.

[An experience of the clinical study with angiography system using a Flat Panel Detector].

We had the chance of clinical studies by new proto-type Digital Subtraction Angiography (DSA) System with the Flat Panel Detector (FPD). That system has two types of detector, FPD and I.I.-CCD camera, and we can compare with image quality in clinical. We measured and discussed about the physical characteristic data of both detectors. Up to physical characteristic evaluation, FPD has good MTF and SNR performance, comparing with I.I.-CCD camera. In clinical evaluation, DSA image of FPD was superior to that of I.I.-CCD camera by visual comparison of medical doctors. Finally we discussed about the feasibility of replacement of detectors. We expect that DSA system will accept FPD in near future.