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Jiro Watari,Toshihiko Tomita,Katsuyuki Tozawa,Tadayuki Oshima,Hirokazu Fukui,Hiroto Miwa 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.3
Whether Helicobacter pylori eradication actually reduces the risk of metachronous gastric cancer (MGC) development remains a controversial question. In this review, we addressed this topic by reviewing the results of clinical investigations and molecular pathological analyses of the roles of H. pylori eradication and aspirin administration in the prevention of MGC. In regard to the clinical studies, the results of meta-analyses and randomized control trials differ from those of retrospective studies: the former trials show that H. pylori eradication has a preventive effect on MGC, while the latter studies do not. This discrepancy may be at least partly attributable to differences in the follow-up periods: H. pylori eradication is more likely to prevent MGC over a long-term follow-up period (≥5 years) than over a short-term follow-up period. In addition, many studies have shown that aspirin may have an additive effect on MGC-risk reduction after H. pylori eradication has been achieved. Both H. pylori eradication and aspirin use induce molecular alterations in the atrophic gastritis mucosa but not in the intestinal metaplasia. Unfortunately, the molecular pathological analyses of these interventions have been limited by short follow-up periods. Therefore, a long-term prospective cohort is needed to clarify the changes in molecular events caused by these interventions.
Shogo Watari,Takaharu Ichikawa,Hiromasa Shiraishi,Moto Tokunaga,Risa Kubota,Norihiro Kusumi,Tomoyasu Tsushima 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.2
Purpose: The usefulness of the urine loss ratio in the early postoperative period for prognosis of long-term urinary continence after radical prostatectomy has not been fully determined. Materials and Methods: All patients who underwent radical prostatectomy for prostate cancer at our institution between November 2015 and March 2021 were retrospectively included. We investigated the rate of continence achievement 1 year after surgery, as well as the associated risk factors for reduced continence achievement, classified by every 10% of the urine loss ratio. Results: Of the 100 patients with available urine loss ratio data, 66 achieved urinary continence. Ninety-three percent of patients with urine loss ratios of ≤10%, 40%–75% of patients with urine loss ratios of 11%–80%, and 20%–36% of patients with urine loss ratios of >80%, achieved continence. The logistic regression analysis showed that the urine loss ratio severity, body mass index (BMI) of >25 kg/m2, and smoking history were unfavorable to achieve urinary continence. A BMI of ≤25 kg/m2 was favorable for urinary continence achievement, but only up to an 80% urine loss ratio. Nonsmokers achieved continence well, even with a urine loss ratio of >80%. Conclusions: Classifying patients into three groups based on their urine loss ratios is potentially useful for urinary continence prognosis. Smoking and obesity were risk factors for continued urinary incontinence, although the prognostic accuracy was expected to improve when considering the severity of the urine loss ratio.
Tatsuya Kato,Hidemichi Watari,Mahito Takeda,Masayoshi Hosaka,Takashi Mitamura,Noriko Kobayashi,Satoko Sudo,Masanori Kaneuchi,Masataka Kudo,Noriaki Sakuragi 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.3
Objective: The aim of this study was to investigate the prognostic factors and treatment outcome of patients with adenocarcinoma of the uterine cervix who underwent radical hysterectomy with systematic lymphadenectomy. Methods: A total of 130 patients with stage IB to IIB cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy from 1982 to 2005 were retrospectively analyzed. Clinicopathological data including age, stage, tumor size, the number of positive node sites, lymphovascular space invasion, parametrial invasion, deep stromal invasion (>2/3 thickness), corpus invasion, vaginal infiltration, and ovarian metastasis, adjuvant therapy, and survival were collected and Cox regression analysis was used to determine independent prognostic factors. Results: An estimated five-year survival rate of stage IB1 was 96.6%, 75.0% in stage IB2, 100% in stage IIA, and 52.8% in stage IIB. Prognosis of patients with one positive-node site is similar to that of those with negative-node. Prognosis of patients with multiple positive-node sites was significantly poorer than that of negative and one positive-node site. Multivariate analysis revealed that lymph node metastasis, lymphovascular space invasion, and parametrial invasion were independent prognostic factors for cervical adenocarcinoma. Survival of patients with cervical adenocarcinoma was stratified into three groups by the combination of three independent prognostic factors. Conclusion: Lymph node metastasis, lymphovascular space invasion, and parametrial invasion were shown to be independent prognostic factors for cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy.
Lymphadenectomy can be omitted for low-risk endometrial cancer based on preoperative assessments
Takashi Mitamura,Hidemichi Watari,Yukiharu Todo,Tatsuya Kato,Yosuke Konno,Masayoshi Hosaka,Noriaki Sakuragi 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.4
Objective: According to the International Federation of Gynecology and Obstetrics staging, some surgeons perform lymphadenectomy in all patients with early stage endometrial cancer to enable the accurate staging. However, there are some risks to lymphadenectomy such as lower limb lymphedema. The aim of this study was to investigate whether preoperative assessment is useful to select the patients in whom lymphadenectomy can be safely omitted. Methods: We evaluated the risk of lymph node metastasis (LNM) using LNM score (histological grade, tumor volume measured in magnetic resonance imaging [MRI], and serum CA-125), myometrial invasion and extrautrerine spread assessed by MRI. Fifty-six patients of which LNM score was 0 and myometrial invasion was less than 50% were consecutively enrolled in the study in which a lymphadenectomy was initially intended not to perform. We analyzed several histological findings and investigated the recurrence rate and overall survival. Results: Fifty-one patients underwent surgery without lymphadenectomy. Five (8.9%) who had obvious myometrial invasion intraoperatively underwent systematic lymphadenectomy. One (1.8%) with endometrial cancer which was considered to arise from adenomyosis had para-aortic LNM. Negative predictive value of deep myometrial invasion was 96.4% (54/56). During the mean follow-up period of 55 months, one patient with deep myometrial invasion who refused an adjuvant therapy had tumor recurrence. The overall survival rate was 100% during the study period. Conclusion: This preoperative assessment is useful to select the early stage endometrial cancer patients without risk of LNM and to safely omit lymphadenectomy.
Multivariate survival analysis of the patients with recurrent endometrial cancer
Tetsuji Odagiri,Hidemichi Watari,Masayoshi Hosaka,Takashi Mitamura,Yousuke Konno,Tatsuya Kato,Noriko Kobayashi,Satoko Sudo,Mahito Takeda,Masanori Kaneuchi,Noriaki Sakuragi 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.1
Objective: Few studies on the prognosticators of the patients with recurrent endometrial cancer after relapse have been reported in the literature. The aim of this study was to determine the prognosticators after relapse in patients with recurrent endometrial cancer who underwent primary complete cytoreductive surgery and adjuvant chemotherapy. Methods: Thirty-five patients with recurrent endometrial cancer were included in this retrospective analysis. The prognostic significance of several clinicopathological factors including histologic type, risk for recurrence, time to relapse after primary surgery, number of relapse sites, site of relapse, treatment modality, and complete resection of recurrent tumors were evaluated. Survival analyses were performed by Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. Results: Among the clinicopathological factors analyzed, histologic type (p=0.04), time to relapse after primary surgery (p=0.03), and the number of relapse sites (p=0.03) were significantly related to survival after relapse. Multivariate analysis revealed that time to relapse after primary surgery (hazard ratio, 6.8; p=0.004) and the number of relapse sites (hazard ratio, 11.1; p=0.002) were independent prognostic factors for survival after relapse. Survival after relapse could be stratified into three groups by the combination of two independent prognostic factors. Conclusion: We conclude that time to relapse after primary surgery, and the number of relapse sites were independent prognostic factors for survival after relapse in patients with recurrent endometrial cancer. Objective: Few studies on the prognosticators of the patients with recurrent endometrial cancer after relapse have been reported in the literature. The aim of this study was to determine the prognosticators after relapse in patients with recurrent endometrial cancer who underwent primary complete cytoreductive surgery and adjuvant chemotherapy. Methods: Thirty-five patients with recurrent endometrial cancer were included in this retrospective analysis. The prognostic significance of several clinicopathological factors including histologic type, risk for recurrence, time to relapse after primary surgery, number of relapse sites, site of relapse, treatment modality, and complete resection of recurrent tumors were evaluated. Survival analyses were performed by Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. Results: Among the clinicopathological factors analyzed, histologic type (p=0.04), time to relapse after primary surgery (p=0.03), and the number of relapse sites (p=0.03) were significantly related to survival after relapse. Multivariate analysis revealed that time to relapse after primary surgery (hazard ratio, 6.8; p=0.004) and the number of relapse sites (hazard ratio, 11.1; p=0.002) were independent prognostic factors for survival after relapse. Survival after relapse could be stratified into three groups by the combination of two independent prognostic factors. Conclusion: We conclude that time to relapse after primary surgery, and the number of relapse sites were independent prognostic factors for survival after relapse in patients with recurrent endometrial cancer.