Annual Report 2022

Department of Urology

Yoshiyuki Matsui, Motokiyo Komiyama, Eijiro Nakamura, Yasuo Shinoda, Ayumu Matsuda, Aiko Maejima, Hiroyuki Fujimoto

Introduction

 In the Department of Urology, all urogenital malignant diseases, including adrenal cancer, kidney cancer, urothelial cancer, prostate cancer, testicular germ cell tumors, and retroperitoneal sarcoma, are the subject of diagnosis and surgical aspects of treatment with comprehensive approaches.

The Team and What We Do

 Since April 2022, the primary responsibility for pharmacological treatments has been transferred to the Department of Medical Oncology, while the Department of Urology focuses on surgical treatments. Among the staff physicians, Dr. Nakamura and Dr. Maejima are actively involved in the Department of Medical Oncology as well. As a major achievement in patient care, we have conducted a total of 339 surgical procedures under general anesthesia (excluding examinations) (Table 1).

 We have introduced robot-assisted radical nephrectomy and radical nephroureterectomy as new robot-assisted procedures. Furthermore, the number of referred cases with refractory/difficult-to-treat conditions requiring multidisciplinary approaches, such as retroperitoneal sarcomas and advanced testicular tumors, remains stable at 15-20% of the annual surgical caseload. To address these challenging conditions, we have established a collaborative system involving multiple departments to provide multidisciplinary treatment.

Research Activities

 We are actively incorporating robot-assisted and laparoscopic surgery, focusing not only on standard procedures but also on minimizing invasiveness in extensive surgeries for refractory conditions.

 On the clinical research front, we are actively engaged in multicenter studies related to JCOG (Japan Clinical Oncology Group) and JUOG (Japan Urological Oncology Group), as well as industry-sponsored trials, and consistently presenting significant results. We are also advancing biomarker research using clinical specimens in collaboration with research institutions, and a resident presented the outcomes of such research (Takamori H, et al. Prostate. 2022: 82(16):1537-1546).

Clinical Trials

 We are actively involved in the following ongoing protocol studies:

1) A phase III study: A single early intravesical instillation of pirarubicin in the prevention of bladder recurrence after radical nephroureterectomy for upper tract urothelial carcinoma (JCOG1403)

2) A phase III study: Anti PD-L1 antibody (ATEZOLIZUMAB/ MPDL3280A) for muscle invasive bladder cancer

3) An open -label, randomized phase III study: MK-6482 vs Everolimus in advanced renal cell carcinoma progressing after PD-1/L1 and VEGF-targeted therapies.

4) A randomized controlled phase III trial on continued or paused PD-1 pathway blockade for patients with advanced renal cell carcinoma (JCOG1905)

5) A randomized controlled phase III trial for confirming superiority of local radiotherapy added to anti-androgen therapy for prostate cancer patients with high volume metastasis sensitive to hormone therapy (HimeRT study; JCOG2011)

6) Epidemiological Research and Development of Novel Therapies for von Hippel-Lindau (VHL) Disease (AA Chakraborty and E. Nakamura et al. Sci Transl Med. 2017. SK Flores and E. Nakamura et al. J Clin Endocrinol Metab. 2019.).

7) Epidemiological Research and Development of Novel Therapies for Pheochromocytoma (M Yonamine and E. Nakamura et al. Cancers (Basel). 2021 Aug 9;13(16):4014. doi: 10.3390/cancers13164014.).

Education

 We provide education to urology residents and accept residents from surgical and gynecological departments. We actively instruct residents in laparoscopic or robotic surgeries, and one resident has obtained certification as a urological laparoscopic technique-certified physician. We strongly encourage residents to participate in clinical research and actively support their involvement in presenting at conferences and publishing papers.

Future Prospects

 As our department's goals, we have outlined the following:

1) In standard treatments, we actively incorporate laparoscopic and robotic surgical techniques to advance minimally invasive therapies.

2) We aim to advance the development of treatment options suitable for elderly and vulnerable patients through protocolization of multidisciplinary treatments for refractory conditions and the proactive introduction of robotic and laparoscopic surgeries.

3) We are transferring the complex aspects of drug therapy to the Department of Oncology, focusing on advancing more advanced surgical interventions and localized therapies.

List of papers published in 2022

Journal

1. Kirisawa T, Shiota M, Kimura T, Edamura K, Miyake M, Morizane S, Yoshino T, Matsukawa A, Matsumoto R, Kasahara T, Nishiyama N, Eto M, Kitamura H, Nakamura E, Matsui Y. Comparison of therapeutic features and oncologic outcome in patients with pN1 prostate cancer among robot-assisted, laparoscopic, or open radical prostatectomy. International journal of clinical oncology, 28:306-313, 2023

2. Takamori H, Yamasaki T, Kitadai R, Minamishima YA, Nakamura E. Development of drugs targeting hypoxia-inducible factor against tumor cells with VHL mutation: Story of 127 years. Cancer science, 114:1208-1217, 2023

3. Takahashi A, Muraoka Y, Koyasu S, Arakawa Y, Nakamura E, Tsujikawa A. Novel Manifestation of Retinal Hemangioblastomas Detected by OCT Angiography in von Hippel-Lindau Disease. Ophthalmology, 2023

4. Takamori H, Maeshima AM, Kato I, Baba M, Nakamura E, Matsui Y. TFEB-translocated and -amplified renal cell carcinoma with VEGFA co-amplification: A case of long-term control by multimodal therapy including a vascular endothelial growth factor-receptor inhibitor. IJU case reports, 6:161-164, 2023

5. Ida H, Koyama T, Mizuno T, Sunami K, Kubo T, Sudo K, Tao K, Hirata M, Yonemori K, Kato K, Okusaka T, Ohe Y, Matsui Y, Yamazaki N, Ogawa C, Kawai A, Narita Y, Esaki M, Yamamoto N. Clinical utility of comprehensive genomic profiling tests for advanced or metastatic solid tumor in clinical practice. Cancer science, 113:4300-4310, 2022

6. Tomida R, Miyake M, Minato R, Sawada Y, Matsumura M, Iida K, Hori S, Fukui S, Ohyama C, Miyake H, Hongo F, Taoka R, Kobayashi T, Kojima T, Matsui Y, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K, Hashine K. Impact of carcinoma in situ on the outcome of intravesical Bacillus Calmette-Guérin therapy for non-muscle-invasive bladder cancer: a comparative analysis of large real-world data. International journal of clinical oncology, 27:958-968, 2022

7. Narita S, Hatakeyama S, Sakamoto S, Kato T, Inokuchi J, Matsui Y, Kitamura H, Nishiyama H, Habuchi T. Management of prostate cancer in older patients. Japanese journal of clinical oncology, 52:513-525, 2022

8. Urabe F, Matsuzaki J, Ito K, Takamori H, Tsuzuki S, Miki J, Kimura T, Egawa S, Nakamura E, Matsui Y, Fujimoto H, Yamamoto Y, Ochiya T. Serum microRNA as liquid biopsy biomarker for the prediction of oncological outcomes in patients with bladder cancer. International journal of urology, 29:968-976, 2022

9. Kita Y, Ito K, Sano T, Hashimoto K, Mochizuki T, Shiraishi Y, Araki H, Fujiwara M, Kanamaru S, Takahashi T, Hishiki K, Okada T, Ogawa K, Ito M, Kojima T, Nishiyama N, Matsui Y, Nishiyama H, Kitamura H, Kobayashi T. Clinical practice pattern in patients with advanced urothelial cancer who had progressed on pembrolizumab in the pre-enfortumab vedotin era. International journal of urology, 29:647-655, 2022

10. Matsui Y, Matsuda A, Maejima A, Shinoda Y, Nakamura E, Komiyama M, Fujimoto H. The clinical significance of perioperative inflammatory index as a prognostic factor for patients with retroperitoneal soft tissue sarcoma. International journal of clinical oncology, 27:1093-1100, 2022

11. Shiota M, Takamatsu D, Kimura T, Tashiro K, Matsui Y, Tomida R, Saito R, Tsutsumi M, Yokomizo A, Yamamoto Y, Edamura K, Miyake M, Morizane S, Yoshino T, Matsukawa A, Narita S, Matsumoto R, Kasahara T, Hashimoto K, Matsumoto H, Kato M, Akamatsu S, Joraku A, Kato M, Yamaguchi T, Saito T, Kaneko T, Takahashi A, Kato T, Sakamoto S, Enokida H, Kanno H, Terada N, Suekane S, Nishiyama N, Eto M, Kitamura H. Radiotherapy plus androgen deprivation therapy for prostate-specific antigen persistence in lymph node-positive prostate cancer. Cancer science, 113:2386-2396, 2022

12. Arai S, Koido K, Maejima A, Shinoda Y, Komiyama M, Matsui Y, Fujimoto H. [A Survey on the Concomitant Use of Drugs with Enzalutamide in Medical Practice-The Effects and Resultant Decrease in Efficacy]. Gan to kagaku ryoho. Cancer & chemotherapy, 49:557-562, 2022

13. Narita S, Terada N, Nomura K, Sakamoto S, Hatakeyama S, Kato T, Matsui Y, Inokuchi J, Yokomizo A, Tabata KI, Shiota M, Kimura T, Kojima T, Inoue T, Mizowaki T, Sugimoto M, Kitamura H, Kamoto T, Nishiyama H, Habuchi T. Cancer-specific and net overall survival in older patients with de novo metastatic prostate cancer initially treated with androgen deprivation therapy. International journal of urology, 29:1147-1154, 2022

14. Mitani Y, Ohashi S, Kikuchi O, Nakai Y, Ida T, Mizumoto A, Yamamoto Y, Saito T, Kataoka S, Matsubara J, Yamada A, Kanai M, Matsumoto S, Sakai H, Yoshikawa K, Nakamura E, Muto M. HER2 G776S mutation promotes oncogenic potential in colorectal cancer cells when accompanied by loss of APC function. Scientific reports, 12:9213, 2022

15. Inoue T, Miyake M, Nishimura N, Onozawa M, Kashima S, Numakura K, Narita S, Iida K, Uemura M, Matsushita Y, Inokuchi J, Matsui Y, Taoka R, Kojima T, Kobayashi T, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K, Habuchi T. Association of Increased Age With Decreased Response to Intravesical Instillation of Bacille Calmette-Guérin in Patients With High-Risk Non-Muscle Invasive Bladder Cancer: Retrospective Multi-Institute Results From the Japanese Urological Oncology Research Group JUOG-UC-1901-BCG. Urology, 167:158-164, 2022

16. Takamori H, Uetani M, Yoshida T, Ban D, Nakamura E, Fujimoto H, Matsui Y. [A Case of Metastatic Adrenal Tumor with Liver Infiltration which was Successfully Resected by Laparoscopic Surgery Using Both Intraperitoneal and Retroperitoneal Approaches]. Hinyokika kiyo. Acta urologica Japonica, 68:179-183, 2022

17. Murakami Y, Matsumoto K, Miyake M, Amano N, Shimura S, Nishimura N, Iida K, Matsushita Y, Abe T, Yamada T, Uemura M, Matsui Y, Taoka R, Kojima T, Kobayashi T, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K, Iwamura M. Real-world treatment patterns and oncological outcomes in early relapse and refractory disease after bacillus Calmette-Guérin failure in non-muscle-invasive bladder cancer. International journal of urology, 29:1195-1203, 2022

18. Takamori H, Urabe F, Matsuzaki J, Kimura S, Sasaki H, Kimura T, Inaba K, Nakamura E, Matsui Y, Fujimoto H, Ochiya T. Circulating microRNA profiling for prediction of oncological outcomes in prostate cancer patients following radical prostatectomy. The Prostate, 82:1537-1546, 2022