Department of Musculoskeletal Oncology and Rehabilitation

Akira Kawai, Shintaro Iwata, Eisuke Kobayashi, Koichi Ogura, Shuhei Osaki, Suguru Fukushima, Kenji Sato, Chiaki Sato, Yu Toda, Shin Ishihara, Ryuto Tsuchiya, Noriko Watanabe, Takuro Sakurai, Sachiko Yahiro, Mami Oki, Yusuke Okita, Takuya Fukushima, Shota Yokota, Aiko Matsuoka, Kazuhiro Kojima

Introduction

Malignant tumors arising from connective tissue are extremely rare, accounting for only 0.01% of newly developed cancers. The rarity itself sometimes causes problems in treating patients with bone and soft tissue tumors, including retardation of accurate diagnoses and a lack of understanding regarding standardized therapeutic approaches. Since 1962, our department has accumulated a vast array of clinical knowledge regarding musculoskeletal tumors in collaboration with radiologists and pathologists specializing in sarcomas, enabling us to offer well-organized treatment strategies to patients with various types of bone and soft tissue tumors. We have also been conducting basic and clinical studies using accumulated clinical samples and data to establish novel diagnostic methods and therapeutic approaches for treating musculoskeletal tumors. In addition, we have given weight to clinical trials in three different but inseparable fields: surgery, chemotherapy, and radiation therapy for bone and soft tissue tumors.

The Team and What We Do

Our department consists of 6 staff doctors, 4 residents, 4 physiotherapists, 3 occupational therapists, and 2 speech therapists. Occasionally, several fellows from Japan and overseas join our group. Outpatient consultations are held every weekday. A constant number of over 25 patients are hospitalized for surgery, chemotherapy, or radiation therapy. Six to 10 major surgeries for musculoskeletal tumors are routinely performed every week. The number of surgeries in our department in FY2021 was 326, of which 182 were for resection of malignant bone and soft tissue tumors (Table 1). In addition to patients with conditions involving the extremities, we collaborate with other surgeons to perform joint operations for patients involving the trunk, pelvis, and retroperitoneum, which are particularly difficult procedures. For extensive soft tissue defects or resection of major vessels caused by musculoskeletal tumor resection, plastic surgery offers reconstructive options.

As for chemotherapy, we have been conducting neoadjuvant and adjuvant chemotherapy for high-grade bone and soft tissue sarcomas, and palliative chemotherapy for advanced disease, where necessary, in collaboration with medical oncologists. In FY2021, a total of 157 patients were treated with chemotherapy, including both outpatients and inpatients.

As for rehabilitation, in addition to musculoskeletal and cerebrovascular rehabilitation, we actively provide rehabilitation for cancer patients in the perioperative period and after chemotherapy and radiotherapy.

Table 1. Surgical procedure 

Research activities

Given that we have one of the largest numbers of sarcoma cases in Japan, we actively participate in multicenter studies considered necessary for treating sarcomas. In FY2021, we participated in 7 national multi-institutional studies and 6 international studies with research groups in Europe and the United States, and have registered many cases. In FY2021, we published 23 peer-reviewed papers from our department.

We are also working with the National Cancer Center Research Institute to create mouse xenografts of sarcoma tissue and novel sarcoma cell lines and to develop approaches to predicting diagnosis, treatment efficacy, and prognosis for sarcomas through a comprehensive analysis of sarcoma-specific gene mutation analysis and gene expression analysis.

Education

We accepted a total of 5 residents for training in diagnosis, surgery, and chemotherapy of bone and soft tissue tumors in FY2021. They were instructed in the design, planning, and implementation of clinical research and in the preparation of scientific papers, and have achieved many outstanding results, including scientific awards.

Future prospects

To further improve the outcome of malignant bone and soft tissue tumors, we must continue to promote innovative approaches, including surgery using advanced technologies and the development of new drugs, as well as continuing to establish and disseminate standard treatments not only in Japan but also worldwide by conducting multicenter clinical studies led by our hospital.

List of papers published

Journal

1. Tsuchiya R, Yoshimatsu Y, Noguchi R, Sin Y, Ono T, Akiyama T, Sugaya J, Nakatani F, Kojima N, Yoshida A, Ohtori S, Kawai A, Kondo T. Establishment and characterization of NCC-UPS3-C1: a novel patient-derived cell line of undifferentiated pleomorphic sarcoma. Human cell, 35:384-391, 2022

2. Toda Y, Kobayashi E, Yoshida A, Kawai A. Gorham-Stout syndrome mimicking a malignant bone tumor in two adult cases. Japanese journal of clinical oncology, 52:197, 2022

3. Toki S, Sone M, Yoshida A, Nishisho T, Gokita T, Kobayashi E, Nakatani F, Chuman H, Sugawara S, Arai Y, Kawai A. Image-guided core needle biopsy for musculoskeletal lesions. Journal of orthopaedic science: official journal of the Japanese Orthopaedic Association, 27:448-455, 2022

4. Yoshida A, Arai Y, Satomi K, Kubo T, Ryo E, Matsushita Y, Hama N, Sudo K, Komiyama M, Yatabe Y, Shibata T, Ichikawa H, Ichimura K, Kawai A, Mori T. Identification of novel SSX1 fusions in synovial sarcoma. Modern pathology: an official journal of the United States and Canadian Academy of Pathology, Inc, 35:228-239, 2022

5. Ono M, Matsumoto K, Boku N, Fujii N, Tsuchida Y, Furui T, Harada M, Kanda Y, Kawai A, Miyachi M, Murashima A, Nakayama R, Nishiyama H, Shimizu C, Sugiyama K, Takai Y, Fujio K, Morishige KI, Osuga Y, Suzuki N. Indications for fertility preservation not included in the 2017 Japan Society of Clinical Oncology Guideline for Fertility Preservation in Pediatric, Adolescent, and Young Adult Patients treated with gonadal toxicity, including benign diseases. International journal of clinical oncology, 27:301-309, 2022

6. Sin Y, Yoshimatsu Y, Noguchi R, Tsuchiya R, Ono T, Akiyama T, Nakatani F, Sugaya J, Yoshida A, Kawai A, Kondo T. Establishment and characterization of NCC-MPNST6-C1: a novel patient-derived cell line of malignant peripheral nerve sheath tumors. Human cell, 35:400-407, 2022

7. Kido A, Kitagawa Y, Tsukushi S, Iwata S, Ishida Y, Tsukamoto S, Kawai A. Marginal resection for patients with atypical lipomatous tumours of the extremities and trunk wall: a systematic review and meta-analysis. Japanese journal of clinical oncology, 52:151-156, 2022

8. Nakamura T, Kawai A, Sudo A. The incidence of unplanned excision in patients with soft tissue sarcoma: Reports from the Bone and Soft Tissue Tumor registry in Japan. Journal of orthopaedic science: official journal of the Japanese Orthopaedic Association, 27:468-472, 2022

9. Nakamura T, Kawai A, Asanuma K, Hagi T, Sudo A. Is no additional excision after unplanned excision with positive margins justified in patients with small (≦5 cm) high-grade soft-tissue sarcoma?: Analysis from the Bone and Soft Tissue Tumor registry in Japan. Journal of orthopaedic science: official journal of the Japanese Orthopaedic Association, 27:463-467, 2022

10.  Arikawa M, Akazawa S, Kagaya Y, Kawai A, Miyamoto S. Free Flap Reconstruction of Oncologic Gluteal Defects. Annals of plastic surgery, 88:420-424, 2022

11. Tanabe K, Nakanishi Y, Matsumoto S, Yajima S, Kuroe T, Watanabe R, Arai Y, Iwata S, Ito M, Masuda H. Utility of a multidisciplinary team approach with transanal total mesorectal excision for resection of a large pelvic solitary fibrous tumor. IJU case reports, 5:104-107, 2022

12. Abe K, Maeda-Minami A, Ishizu T, Iwata S, Kobayashi E, Shimoi T, Kawano Y, Hashimoto H, Yamaguchi M, Furukawa T, Miyazaki S, Mano Y. Risk Factors for Hepatic Toxicity of High-dose Methotrexate in Patients With Osteosarcoma. Anticancer research, 42:1043-1050, 2022

13.  COVIDSurg Collaborative, GlobalSurg Collaborative . SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia, 77:28-39, 2022

Stacchiotti S, Miah AB, Frezza AM, Messiou C, Morosi C, Caraceni A, Antonescu CR, Bajpai J, Baldini E, Bauer S, Biagini R, Bielack S, Blay JY, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brodowicz T, Callegaro D, De Alava E, Deoras-Sutliff M, Dufresne A, Eriksson M, Errani C, Fedenko A, Ferraresi V, Ferrari A, Fletcher CDM, Garcia Del Muro X, Gelderblom H, Gladdy RA, Gouin F, Grignani G, Gutkovich J, Haas R, Hindi N, Hohenberger P, Huang P, Joensuu H, Jones RL, Jungels C, Kasper B, Kawai A, Le Cesne A, Le Grange F, Leithner A, Leonard H, Lopez Pousa A, Martin Broto J, Merimsky O, Merriam P, Miceli R, Mir O, Molinari M, Montemurro M, Oldani G, Palmerini E, Pantaleo MA, Patel S, Piperno-Neumann S, Raut CP, Ravi V, Razak ARA, Reichardt P, Rubin BP, Rutkowski P, Safwat AA, Sangalli C, Sapisochin G, Sbaraglia M, Scheipl S, Schöffski P, Strauss D, Strauss SJ, Sundby Hall K, Tap WD, Trama A, Tweddle A, van der Graaf WTA, Van De Sande MAJ, Van Houdt W, van Oortmerssen G, Wagner AJ, Wartenberg M, Wood J, Zaffaroni N, Zimmermann C, Casali PG, Dei Tos AP, Gronchi A . Epithelioid hemangioendothelioma, an ultra-rare cancer: a consensus paper from the community of experts. ESMO open, 6:100170, 2021

15.  Yoshimatsu Y, Noguchi R, Tsuchiya R, Sin Y, Ono T, Sugaya J, Iwata S, Yoshida A, Kawai A, Kondo T. Establishment and characterization of NCC-MFS4-C1: a novel patient-derived cell line of myxofibrosarcoma. Human cell, 34:1911-1918, 2021

16. Chen TW, Pang A, Puhaindran ME, Maw MM, Loong HH, Sriuranpong V, Chang CC, Mingmalairak S, Hirose T, Endo M, Kawai A, Farid M, Tan SH, Goh WL, Quek R, Chan JCH, Leung AKC, Ngan RKC. The treatment landscape of advanced angiosarcoma in Asia-A multi-national collaboration from the Asian Sarcoma Consortium. Cancer science, 112:1095-1104, 2021

17. Tsuchiya R, Yoshimatsu Y, Noguchi R, Sin Y, Ono T, Sei A, Takeshita F, Sugaya J, Nakatani F, Yoshida A, Ohtori S, Kawai A, Kondo T. Establishment and characterization of NCC-ssRMS2-C1: a novel patient-derived cell line of spindle cell/sclerosing rhabdomyosarcoma. Human cell, 34:1569-1578, 2021

18. Nakagawa M, Kobayashi E, Yamada M, Watanabe T, Hirata M, Tanabe N, Ushiama M, Sakamoto H, Sato C, Mori T, Yoshida A, Yoshida T, Sugano K, Kawai A. Myxofibrosarcoma harboring an MLH1 pathogenic germline variant associated with Muir-Torre syndrome: a case report. Hereditary cancer in clinical practice, 19:34, 2021

19. Kawai A, Naka N, Shimomura A, Takahashi S, Kitano S, Imura Y, Yonemori K, Nakatani F, Iwata S, Kobayashi E, Outani H, Tamiya H, Naito Y, Yamamoto N, Doi T. Efficacy and safety of TAS-115, a novel oral multi-kinase inhibitor, in osteosarcoma: an expansion cohort of a phase I study. Investigational new drugs, 39:1559-1567, 2021

20. Tsuchiya R, Yoshimatsu Y, Noguchi R, Sin Y, Ono T, Sei A, Takeshita F, Sugaya J, Iwata S, Yoshida A, Ohtori S, Kawai A, Kondo T. Establishment and characterization of NCC-MFS3-C1: a novel patient-derived cell line of myxofibrosarcoma. Human cell, 34:1266-1273, 2021

21. Kohama I, Asano N, Matsuzaki J, Yamamoto Y, Yamamoto T, Takahashi RU, Kobayashi E, Takizawa S, Sakamoto H, Kato K, Fujimoto H, Chikuda H, Kawai A, Ochiya T. Comprehensive serum and tissue microRNA profiling in dedifferentiated liposarcoma. Oncology letters, 22:623, 2021

22. Nakamura T, Kawai A, Asanuma K, Hagi T, Sudo A. Clinical Outcome of Dermatofibrosarcoma Protuberance. Report From the Bone and Soft Tissue Tumor (BSTT) Registry in Japan. In vivo (Athens, Greece), 35:611-615, 2021

23. Frezza AM, Ravi V, Lo Vullo S, Vincenzi B, Tolomeo F, Chen TW, Teterycz P, Baldi GG, Italiano A, Penel N, Brunello A, Duffaud F, Hindi N, Iwata S, Smrke A, Fedenko A, Gelderblom H, Van Der Graaf W, Vozy A, Connolly E, Grassi M, Benjamin RS, Broto JM, Grignani G, Jones RL, Kawai A, Tysarowski A, Mariani L, Casali PG, Stacchiotti S. Systemic therapies in advanced epithelioid haemangioendothelioma: A retrospective international case series from the World Sarcoma Network and a review of literature. Cancer medicine, 10:2645-2659, 2021

24.  Nakagawa M, Sekimizu M, Endo M, Kobayashi E, Iwata S, Fukushima S, Yoshida A, Kitabayashi I, Ichikawa H, Kawai A, Nakatani F. Prognostic impact of IDH mutations in chondrosarcoma. Journal of orthopaedic science: official journal of the Japanese Orthopaedic Association, 2021

25.  Iwata S, Kawai A, Ueda T, Ishii T. Symptomatic Venous Thromboembolism in Patients with Malignant Bone and Soft Tissue Tumors: A Prospective Multicenter Cohort Study. Annals of surgical oncology, 28:3919-3927, 2021

26. Tsuchiya R, Yoshimatsu Y, Noguchi R, Sin Y, Ono T, Akiyama T, Hirose T, Iwata S, Yoshida A, Ohtori S, Kawai A, Kondo T. Establishment and Characterization of NCC-DDLPS4-C1: A Novel Patient-Derived Cell Line of Dedifferentiated Liposarcoma. Journal of personalized medicine, 11:2021

27. Zhang L, Akiyama T, Fukushima T, Iwata S, Takeshita K, Kawai A, Tanaka S, Kobayashi H. Surgical resection of the primary lesion for osteosarcoma patients with metastasis at initial diagnosis. Japanese journal of clinical oncology, 51:416-423, 2021

28. Stacchiotti S, Frezza AM, Blay JY, Baldini EH, Bonvalot S, Bovée JVMG, Callegaro D, Casali PG, Chiang RC, Demetri GD, Demicco EG, Desai J, Eriksson M, Gelderblom H, George S, Gounder MM, Gronchi A, Gupta A, Haas RL, Hayes-Jardon A, Hohenberger P, Jones KB, Jones RL, Kasper B, Kawai A, Kirsch DG, Kleinerman ES, Le Cesne A, Lim J, Chirlaque López MD, Maestro R, Marcos-Gragera R, Martin Broto J, Matsuda T, Mir O, Patel SR, Raut CP, Razak ARA, Reed DR, Rutkowski P, Sanfilippo RG, Sbaraglia M, Schaefer IM, Strauss DC, Sundby Hall K, Tap WD, Thomas DM, van der Graaf WTA, van Houdt WJ, Visser O, von Mehren M, Wagner AJ, Wilky BA, Won YJ, Fletcher CDM, Dei Tos AP, Trama A . Ultra-rare sarcomas: A consensus paper from the Connective Tissue Oncology Society community of experts on the incidence threshold and the list of entities. Cancer, 127:2934-2942, 2021

29. Yoshimatsu Y, Noguchi R, Sin Y, Tsuchiya R, Ono T, Sei A, Sugaya J, Iwata S, Yoshida A, Kawai A, Kondo T. Establishment and characterization of NCC-LGFMS1-C1: a novel patient-derived cell line of low-grade fibromyxoid sarcoma. Human cell, 34:1919-1928, 2021

30. Nakamura T, Kawai A, Hagi T, Asanuma K, Sudo A. A comparison of clinical outcomes between additional excision after unplanned and planned excisions in patients with soft-tissue sarcoma of the limb: a propensity matching cohort study. The bone & joint journal, 103-B:1809-1814, 2021

31. Hagiwara Y, Iwata S, Ogura K, Kawai A, Susa M, Morioka H, Hiruma T, Tsuda Y, Kawano H, Yonemoto T, Ishii T, Okazaki K. Clinical analysis of multimodal treatment for localized synovial sarcoma: A multicenter retrospective study. Journal of orthopaedic science: official journal of the Japanese Orthopaedic Association, 2021

32. Xu G, Aiba H, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Higuchi T, Abe K, Taniguchi Y, Araki Y, Saito S, Yoshimura K, Murakami H, Tsuchiya H, Kawai A. Efficacy of perioperative chemotherapy for synovial sarcoma: a retrospective analysis of a Nationwide database in Japan. BMC cancer, 21:773, 2021

33. Fukushima T, Ogura K, Akiyama T, Takeshita K, Kawai A. Soft tissue sarcoma in adolescent and young adult patients: a retrospective study using a nationwide bone and soft tissue tumor registry in Japan. Japanese journal of clinical oncology, 51:1080-1087, 2021

34. Nishida Y, Urakawa H, Nakayama R, Kobayashi E, Ozaki T, Ae K, Matsumoto Y, Tsuchiya H, Goto T, Hiraga H, Naka N, Takahashi S, Ando Y, Ando M, Kuwatsuka Y, Hamada S, Ueda T, Kawai A. Phase II clinical trial of pazopanib for patients with unresectable or metastatic malignant peripheral nerve sheath tumors. International journal of cancer, 148:140-149, 2021

35. Hayashi K, Hiraoka K, Akiyama T, Iwata S, Tsuchiya H, Kawai A. Benefit of surgical resection of distant metastasis in soft tissue sarcoma: a systematic review. Japanese journal of clinical oncology, 51:1088-1093, 2021

36. Nakamura T, Saito Y, Tsuchiya K, Miyachi M, Iwata S, Sudo A, Kawai A. Is perioperative chemotherapy recommended in childhood and adolescent patients with synovial sarcoma? A systematic review. Japanese journal of clinical oncology, 51:927-931, 2021

37. Yoshimatsu Y, Noguchi R, Tsuchiya R, Ono T, Sin Y, Akane S, Sugaya J, Mori T, Fukushima S, Yoshida A, Kawai A, Kondo T. Establishment and characterization of novel patient-derived cell lines from giant cell tumor of bone. Human cell, 34:1899-1910, 2021

38. Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, SchÖffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S . Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up(☆). Annals of oncology: official journal of the European Society for Medical Oncology, 32:1348-1365, 2021

39. Zhang L, Akiyama T, Fukushima T, Iwata S, Tsuda Y, Takeshita K, Kawai A, Tanaka S, Kobayashi H. Prognostic factors and impact of surgery in patients with metastatic soft tissue sarcoma at diagnosis: A population-based cohort study. Japanese journal of clinical oncology, 51:918-926, 2021

40. Nagano A, Tsugita M, Nishimoto Y, Akiyama H, Kawai A. The 'other' bone sarcomas in Japan: a retrospective study of primary bone sarcomas other than osteosarcoma, Ewing sarcoma and chondrosarcoma, using data from the Bone Tumuor Registry in Japan. Japanese journal of clinical oncology, 51:1430-1436, 2021

41. Fukushima T, Tsuji T, Watanabe N, Sakurai T, Matsuoka A, Kojima K, Yahiro S, Oki M, Okita Y, Yokota S, Nakano J, Sugihara S, Sato H, Kawakami J, Kagaya H, Tanuma A, Sekine R, Mori K, Zenda S, Kawai A. The current status of inpatient cancer rehabilitation provided by designated cancer hospitals in Japan. Japanese journal of clinical oncology, 51:1094-1099, 2021

42. Takenaka S, Tamiya H, Wakamatsu T, Nakai S, Imura Y, Outani H, Yagi T, Kawai A. Impact of Surgical Resection and Reasons for Poor Prognosis of Pelvic Osteosarcoma Based on the Bone Tumor Registry in Japan. Cancers, 13:2021

43.  Emori M, Iba K, Murahashi Y, Shimizu J, Sonoda T, Wada T, Yamashita T, Kawai A. Oncological and prognostic analysis of soft tissue sarcoma of the elbow: report using the bone and soft tissue tumor registry in Japan. Japanese journal of clinical oncology, 51:1608-1614, 2021

44. Jones RL, Wagner AJ, Kawai A, Tamura K, Shahir A, Van Tine BA, Martín-Broto J, Peterson PM, Wright J, Tap WD . Prospective Evaluation of Doxorubicin Cardiotoxicity in Patients with Advanced Soft-tissue Sarcoma Treated in the ANNOUNCE Phase III Randomized Trial. Clinical cancer research: an official journal of the American Association for Cancer Research, 27:3861-3866, 2021

45. Brohl AS, Sindiri S, Wei JS, Milewski D, Chou HC, Song YK, Wen X, Kumar J, Reardon HV, Mudunuri US, Collins JR, Nagaraj S, Gangalapudi V, Tyagi M, Zhu YJ, Masih KE, Yohe ME, Shern JF, Qi Y, Guha U, Catchpoole D, Orentas RJ, Kuznetsov IB, Llosa NJ, Ligon JA, Turpin BK, Leino DG, Iwata S, Andrulis IL, Wunder JS, Toledo SRC, Meltzer PS, Lau C, Teicher BA, Magnan H, Ladanyi M, Khan J. Immuno-transcriptomic profiling of extracranial pediatric solid malignancies. Cell reports, 37:110047, 2021

46. Iwata S, Tatsumi Y, Yonemoto T, Araki A, Itami M, Kamoda H, Tsukanishi T, Hagiwara Y, Kinoshita H, Ishii T, Nagase H, Ohira M. CDK4 overexpression is a predictive biomarker for resistance to conventional chemotherapy in patients with osteosarcoma. Oncology reports, 46:2021

47.  Yokoo S, Fujiwara T, Yoshida A, Uotani K, Morita T, Kiyono M, Hasei J, Nakata E, Kunisada T, Iwata S, Yonemoto T, Ueda K, Ozaki T. Liquid Biopsy Targeting Monocarboxylate Transporter 1 on the Surface Membrane of Tumor-Derived Extracellular Vesicles from Synovial Sarcoma. Cancers, 13:2021

48. Horiuchi K, Kobayashi E, Mizuno T, Susa M, Chiba K. Hypercalcemia following discontinuation of denosumab therapy: A systematic review. Bone reports, 15:101148, 2021

49. Outani H, Kobayashi E, Wasa J, Saito M, Takenaka S, Hayakawa K, Endo M, Takeuchi A, Kobayashi H, Kito M, Morii T, Imanishi J, Ueda T. Clinical Outcomes of Patients with Metastatic Solitary Fibrous Tumors: A Japanese Musculoskeletal Oncology Group (JMOG) Multiinstitutional Study. Annals of surgical oncology, 28:3893-3901, 2021

50.  COVIDSurg Collaborative. Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study. Anaesthesia, 76:1454-1464, 2021

51.  Shibayama T, Makise N, Motoi T, Mori T, Hiraoka N, Yonemori K, Watanabe SI, Esaki M, Morizane C, Okuma T, Kawai A, Ushiku T, Yatabe Y, Yoshida A. Clinicopathologic Characterization of Epithelioid Hemangioendothelioma in a Series of 62 Cases: A Proposal of Risk Stratification and Identification of a Synaptophysin-positive Aggressive Subset. The American journal of surgical pathology, 45:616-626, 2021

52.  Suehara Y, Kohsaka S, Hayashi T, Akaike K, Kurisaki-Arakawa A, Sato S, Kobayashi E, Mizuno S, Ueno T, Morii T, Okuma T, Kurihara T, Hasegawa N, Sano K, Sasa K, Okubo T, Kim Y, Mano H, Saito T. Identification of a Novel MAN1A1-ROS1 Fusion Gene Through mRNA-based Screening for Tyrosine Kinase Gene Aberrations in a Patient with Leiomyosarcoma. Clinical orthopaedics and related research, 479:838-852, 2021

53.  Umeda K, Miyamura T, Yamada K, Sano H, Hosono A, Sumi M, Okita H, Kumamoto T, Kawai A, Hirayama J, Jyoko R, Sawada A, Nakayama H, Hosoya Y, Maeda N, Yamamoto N, Imai C, Hasegawa D, Chin M, Ozaki T. Clinical outcome of patients with recurrent or refractory localized Ewing's sarcoma family of tumors: A retrospective report from the Japan Ewing Sarcoma Study Group. Cancer reports (Hoboken, N.J.), 4:e1329, 2021

54. Kohsaka S, Hirata M, Ikegami M, Ueno T, Kojima S, Sakai T, Ito K, Naka N, Ogura K, Kawai A, Iwata S, Okuma T, Yonemoto T, Kobayashi H, Suehara Y, Hiraga H, Kawamoto T, Motoi T, Oda Y, Matsubara D, Matsuda K, Nishida Y, Mano H. Comprehensive molecular and clinicopathological profiling of desmoid tumours. European journal of cancer (Oxford, England: 1990), 145:109-120, 2021

55. Hirozane T, Masuda M, Sugano T, Sekita T, Goto N, Aoyama T, Sakagami T, Uno Y, Moriyama H, Sawa M, Asano N, Nakamura M, Matsumoto M, Nakayama R, Kondo T, Kawai A, Kobayashi E, Yamada T. Direct conversion of osteosarcoma to adipocytes by targeting TNIK. JCI insight, 6:2021

56.  Tsuchiya R, Yoshimatsu Y, Noguchi R, Sei A, Takeshita F, Sugaya J, Fukushima S, Yoshida A, Ohtori S, Kawai A, Kondo T. Establishment and characterization of NCC-DDLPS1-C1: a novel patient-derived cell line of dedifferentiated liposarcoma. Human cell, 34:260-270, 2021

57. Tsuchiya R, Yoshimatsu Y, Noguchi R, Ono T, Sei A, Takeshita F, Sugaya J, Fukushima S, Yoshida A, Ohtori S, Kawai A, Kondo T. Establishment and characterization of NCC-DDLPS3-C1: a novel patient-derived cell line of dedifferentiated liposarcoma. Human cell, 34:1008-1018, 2021

58.  Tsuchiya R, Yoshimatsu Y, Noguchi R, Ono T, Sei A, Takeshita F, Sugaya J, Iwata S, Yoshida A, Ohtori S, Kawai A, Kondo T. Establishment and characterization of NCC-SS4-C1: a novel patient-derived cell line of synovial sarcoma. Human cell, 34:998-1007, 2021

59. Kim Y, Kobayashi E, Suehara Y, Ito A, Kubota D, Tanzawa Y, Endo M, Nakatani F, Nakatsura T, Kawai A, Kaneko K, Kitano S. Immunological status of peripheral blood is associated with prognosis in patients with bone and soft-tissue sarcoma. Oncology letters, 21:212, 2021

60. Wada S, Sadahiro R, Matsuoka YJ, Uchitomi Y, Yamaguchi T, Sato T, Shimada K, Yoshimoto S, Daiko H, Kanemitsu Y, Kawai A, Kato T, Fujimoto H, Shimizu K. Yokukansan for Treatment of Preoperative Anxiety and Prevention of Postoperative Delirium in Cancer Patients Undergoing Highly Invasive Surgery. J-SUPPORT 1605 (ProD Study): A Randomized, Double-Blind, Placebo-Controlled Trial. Journal of pain and symptom management, 61:71-80, 2021