Annual Report 2023

Department of Thoracic Surgery

Shun-ichi Watanabe, Kazuo Nakagawa, Yukihiro Yoshida, Masaya Yotsukura, Yuma Fukumoto, Chihiro Takemura

Introduction

 The Department of Thoracic Surgery deals with various kinds of neoplasms and allied diseases in the thorax, except the esophagus. These include both primary and metastatic lung tumors, mediastinal tumors, pleural tumors (mesotheliomas) and chest wall tumors. The main clinical activity of our department and the subject of most of its research activities has been the surgical management of patients with lung cancer.

The Team and What We Do

 Our department has 4 attending surgeons and resident surgeons who perform all the inpatient care, surgeries, examinations, and outpatient care. In 2023, we performed a total of 746 operations, including lung cancer in 650, metastatic tumors in 11, mediastinal tumors in 45 and other tumors in 40 patients (Tables 1 and 2).

 The treatment strategy for patients with lung cancer is based on tumor histology (non-small cell vs. small cell), the extent of the disease (clinical stage) and the physical status of the patient. Surgical resection is usually indicated for clinical stages I, II and some III with non-small cell lung cancer [NSCLC] and clinical stage I with small cell lung cancer [SCLC] in patients with lung cancer. Whereas, to improve the poor prognosis of patients with clinically and histologically proven mediastinal lymph node metastasis or with invasion of vital neighboring structures, optimal treatment modalities are sought in a clinical trial setting. In addition, adjuvant therapy has often been given to patients with advanced lung cancer, even after complete resection.

 For metastatic lung tumors, resection has been attempted based on Thomford’s criteria. For mediastinal tumors, thymic epithelial tumors are most commonly encountered for resection. Meanwhile, treatment must be carefully determined by cytologic/histologic diagnosis preoperatively in the mediastinum, where various tumor histologies can arise.

 As for meetings, there are two department meetings. One is for the preoperative evaluation and postoperative inpatient review on Fridays and the other is for the journal club on Wednesdays.

Research Activities

 Lymph node dissection for lung cancer has been a major issue in lung cancer treatment and has been extensively studied in our department. We continue to improve our surgical dissection technique, taking oncological and surgical aspects into consideration: a more effective and less invasive lymph node dissection called “selective mediastinal/hilar dissection”, according to the primary tumor location by the lobe. Minimally invasive open surgery (MIOS) is also an important challenge in our department. Recently, the role of segmentectomy has become more important because of the increasing detection rate for early-stage NSCLC. We have actively performed segmentectomy in recent years. In 2023, we performed the largest number of segmentectomies as well as lung cancer surgeries in Japan.

Clinical Trials

 Our department has played an important role as a leading hospital in the Japan Clinical Oncology Group (JCOG) - Lung Cancer Surgical Study Group (LCSSG). To date, the LCSSG has conducted a lot of clinical trials for lung cancer surgery.

 With the increased frequency of the early detection rate of small-sized or ground-glass opacity (GGO) lung tumors, the optimal mode of resection: limited resection (segmentectomy and wedge resection) or standard resection (lobectomy) remains controversial. In addition, GGO tumors are well known to have an indolent behavior, so some cases might be followed up with careful monitoring by CT. Accordingly, the best management of such patients not only with resection but also with observation needs to be explored. Three clinical trials to determine the appropriateness of limited resection for early-stage NSCLC (JCOG0802, JCOG0804, and JCOG1211) have been conducted since the end of 2009. The results of these 3 trials were published, and the role of limited resection has been established. These 3 trials from the LCSSG could lead to major shifts in clinical practice towards limited resection for early-stage NSCLC. For GGO tumors, JCOG1906: a prospective evaluation of watchful waiting for early-stage lung cancer with GGO opened to accrual in June 2020. JCOG2217: a prospective randomized trial comparing lobectomy vs. segmentectomy for solid dominant tumor 2.1-3.0 cm in size opened to accrual in March 2024.

 Investigating the appropriate resection mode for compromised patients is also crucial. Three clinical trials are ongoing: JCOG1708, sublobar resection versus lobectomy for patients with resectable stage I NSCLC with idiopathic pulmonary fibrosis (opened to accrual in May 2018); JCOG1909, anatomical segmentectomy versus wedge resection in high-risk operable patients with clinical stage IA NSCLC (opened to accrual in April 2020); and JCOG2109, anatomical segmentectomy versus wedge resection for small (≤2 cm) peripheral NSCLC in 80 or more aged elderly patients (opened to accrual in October 2022). In addition, JCOG1710A, daily living activities in elderly patients who have undergone lung cancer surgery, completed the full accrual of 986 patients.

 As for lymph node dissection, JCOG1413: lobe-specific versus systematic nodal dissection for c-stage I/II NSCLC, completed the full accrual of 1507 patients. We await the maturation of follow-up data.

 Regarding adjuvant or neoadjuvant therapy, JCOG1916: postoperative radiotherapy for pathological N2 NSCLC with adjuvant chemotherapy opened to accrual in January 2021. Furthermore, JCOG1807C: efficacy and safety of durvalumab before and after operation or durvalumab as maintenance therapy after chemoradiotherapy against superior sulcus NSCLC opened to accrual in September 2020.

 The relevance of postoperative follow-up and surveillance modalities remains debated after the NSCLC resection. JCOG2012: postoperative surveillance for pathological stage II-IIIA NSCLC opened to accrual in October 2022.

 The LCSSG in the JCOG continues to establish ideal surgical treatment strategies for lung cancer.

List of papers published in 2023

Journal

1. Hattori A, Suzuki K, Takamochi K, Wakabayashi M, Sekino Y, Tsutani Y, Nakajima R, Aokage K, Saji H, Tsuboi M, Okada M, Asamura H, Nakamura K, Fukuda H, Watanabe SI. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer with radiologically pure-solid appearance in Japan (JCOG0802/WJOG4607L): a post-hoc supplemental analysis of a multicentre, open-label, phase 3 trial. The Lancet. Respiratory medicine, 12:105-116, 2024

2. Akamine T, Nakagawa K, Ito K, Watanabe H, Yotsukura M, Yoshida Y, Yatabe Y, Kusumoto M, Watanabe SI. Impact of (18)F-FDG PET on TNM Staging and Prognosis in Thymic Epithelial Tumors. Annals of surgical oncology, 31:192-200, 2024

3. Shiraishi K, Takahashi A, Momozawa Y, Daigo Y, Kaneko S, Kawaguchi T, Kunitoh H, Matsumoto S, Horinouchi H, Goto A, Honda T, Shimizu K, Torasawa M, Takayanagi D, Saito M, Saito A, Ohe Y, Watanabe SI, Goto K, Tsuboi M, Tsuchihara K, Takata S, Aoi T, Takano A, Kobayashi M, Miyagi Y, Tanaka K, Suzuki H, Maeda D, Yamaura T, Matsuda M, Shimada Y, Mizuno T, Sakamoto H, Yoshida T, Goto Y, Yoshida T, Yamaji T, Sonobe M, Toyooka S, Yoneda K, Masago K, Tanaka F, Hara M, Fuse N, Nishizuka SS, Motoi N, Sawada N, Nishida Y, Kumada K, Takeuchi K, Tanno K, Yatabe Y, Sunami K, Hishida T, Miyazaki Y, Ito H, Amemiya M, Totsuka H, Nakayama H, Yokose T, Ishigaki K, Nagashima T, Ohtaki Y, Imai K, Takasawa K, Minamiya Y, Kobayashi K, Okubo K, Wakai K, Shimizu A, Yamamoto M, Iwasaki M, Matsuda K, Inazawa J, Shiraishi Y, Nishikawa H, Murakami Y, Kubo M, Matsuda F, Kamatani Y, Hamamoto R, Matsuo K, Kohno T. Identification of telomere maintenance gene variations related to lung adenocarcinoma risk by genome-wide association and whole genome sequencing analyses. Cancer communications (London, England), 44:287-293, 2024

4. Adachi H, Morohoshi T, Shintani Y, Okami J, Ito H, Ohtsuka T, Mori T, Watanabe SI, Chida M, Endo S, Nakanishi R, Kadokura M, Suzuki H, Miyaoka E, Yoshino I, Date H. Benefit of Adjuvant Chemotherapy for Patients Older Than 75 Years With Completely Resected p-Stage II-IIIA Non-Small-Cell Lung Cancer: A Retrospective Cohort Study Using Japanese Nationwide Real-World Data. Clinical lung cancer, 25:61-71.e1, 2024

5. Takamori S, Yatabe Y, Osoegawa A, Aokage K, Yoshioka H, Miyoshi T, Mimae T, Endo M, Hattori A, Yotsukura M, Isaka T, Isaka M, Maniwa T, Nakajima R, Watanabe SI. Rare but clinically important salivary gland-type tumor of the lung: A review. Japanese journal of clinical oncology, 54:121-128, 2024

6. Kobayashi K, Gu L, Hataya R, Mizuno T, Miyake M, Watanabe H, Takahashi M, Takamizawa Y, Yoshida Y, Nakamura S, Kouno N, Bolatkan A, Kurose Y, Harada T, Hamamoto R. Sketch-based semantic retrieval of medical images. Medical image analysis, 92:103060, 2024

7. Ohashi K, Nishito Y, Fukuda H, Sadahiro R, Yoshida Y, Watanabe SI, Motoi N, Sonobe Y, Mizuno H, Tsunoda H, Tatsumi K, Suzuki T, Ochiai A, Aoki K. Neutrophil-to-lymphocyte ratio is a prognostic factor reflecting immune condition of tumor microenvironment in squamous cell lung cancer. Scientific reports, 14:429, 2024

8. Sugawara H, Kikkawa N, Ito K, Watanabe H, Kaku S, Akai H, Abe O, Watanabe SI, Yatabe Y, Kusumoto M. Is 18F-fluorodeoxyglucose PET recommended for small lung nodules? CT findings of 18F-fluorodeoxyglucose non-avid lung cancer. The British journal of radiology, 97:462-468, 2024

9. Mochizuki A, Shiraishi K, Honda T, Higashiyama RI, Sunami K, Matsuda M, Shimada Y, Miyazaki Y, Yoshida Y, Watanabe SI, Yatabe Y, Hamamoto R, Kohno T. Passive Smoking-Induced Mutagenesis as a Promoter of Lung Carcinogenesis. Journal of thoracic oncology, S1556-0864(24)00074-1, 2024

10. Takasawa K, Asada K, Kaneko S, Shiraishi K, Machino H, Takahashi S, Shinkai N, Kouno N, Kobayashi K, Komatsu M, Mizuno T, Okubo Y, Mukai M, Yoshida T, Yoshida Y, Horinouchi H, Watanabe SI, Ohe Y, Yatabe Y, Kohno T, Hamamoto R. Advances in cancer DNA methylation analysis with methPLIER: use of non-negative matrix factorization and knowledge-based constraints to enhance biological interpretability. Experimental & molecular medicine, 56:646-655, 2024

11. Rami-Porta R, Nishimura KK, Giroux DJ, Detterbeck F, Cardillo G, Edwards JG, Fong KM, Giuliani M, Huang J, Kernstine KH Sr, Marom EM, Nicholson AG, Van Schil PE, Travis WD, Tsao MS, Watanabe SI, Rusch VW, Asamura H. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groups in the Forthcoming (Ninth) Edition of the TNM Classification for Lung Cancer. Journal of thoracic oncology, S1556-0864(24)00079-0, 2024

12. Gill RR, Nowak AK, Giroux DJ, Eisele M, Rosenthal A, Kindler H, Wolf A, Ripley RT, Billé A, Rice D, Opitz I, Rimner A, de Perrot M, Pass HI, Rusch VW. The International Association for the Study of Lung Cancer Mesothelioma Staging Project: Proposals for Revisions of the "T" Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Pleural Mesothelioma. Journal of thoracic oncology, S1556-0864(24)00086-8, 2024

13. Fukuda H, Arai K, Mizuno H, Nishito Y, Motoi N, Arai Y, Hiraoka N, Shibata T, Sonobe Y, Kayukawa Y, Hashimoto E, Takahashi M, Fujii E, Maruyama T, Kuwabara K, Nishizawa T, Mizoguchi Y, Yoshida Y, Watanabe SI, Yamashita M, Kitano S, Sakamoto H, Nagata Y, Mitsumori R, Ozaki K, Niida S, Kanai Y, Hirayama A, Soga T, Tsukada K, Yabuki N, Shimada M, Kitazawa T, Natori O, Sawada N, Kato A, Yoshida T, Yasuda K, Ochiai A, Tsunoda H, Aoki K. Molecular subtypes of lung adenocarcinoma present distinct immune tumor microenvironments. Cancer science, 115:1763-1777, 2024

14. Yano K, Yotsukura M, Watanabe H, Akamine T, Yoshida Y, Nakagawa K, Yatabe Y, Kusumoto M, Watanabe SI. Oncological feasibility of segmentectomy for inner-located lung cancer. JTCVS open, 18:261-275, 2024

15. Takei H, Kunitoh H, Wakabayashi M, Kataoka T, Sekino Y, Mizutani T, Tsuboi M, Ikeda N, Asamura H, Okada M, Takahama M, Ohde Y, Okami J, Shiono S, Aokage K, Watanabe SI. Prospective, Multi-Institutional Observational Study of Deterioration in Activities of Daily Living in Elderly Patients After Lung Cancer Surgery. JTO clinical and research reports, 4:100550, 2023

16. Yoshino I, Moriya Y, Suzuki K, Wakabayashi M, Saji H, Aokage K, Suzuki M, Ito H, Matsumoto I, Kobayashi M, Okamoto T, Okada M, Yamashita M, Ikeda N, Nakamura S, Kataoka T, Tsuboi M, Watanabe SI. Long-term outcome of patients with peripheral ground-glass opacity-dominant lung cancer after sublobar resections. The Journal of thoracic and cardiovascular surgery, 166:1222-1231.e1, 2023

17. Miyoshi T, Ito H, Wakabayashi M, Hashimoto T, Sekino Y, Suzuki K, Tsuboi M, Moriya Y, Yoshino I, Isaka T, Hattori A, Mimae T, Isaka M, Maniwa T, Endo M, Yoshioka H, Nakagawa K, Nakajima R, Tsutani Y, Saji H, Okada M, Aokage K, Fukuda H, Watanabe SI. Risk factors for loss of pulmonary function after wedge resection for peripheral ground-glass opacity dominant lung cancer. European journal of cardio-thoracic surgery, 64:ezad365, 2023

18. Maniwa T, Okami J, Miyoshi T, Wakabayashi M, Yoshioka H, Mimae T, Endo M, Hattori A, Nakagawa K, Isaka T, Isaka M, Kita R, Sekino Y, Mitome N, Aokage K, Saji H, Nakajima R, Okada M, Tsuboi M, Asamura H, Fukuda H, Watanabe SI. Lymph node dissection in small peripheral lung cancer: Supplemental analysis of JCOG0802/WJOG4607L. The Journal of thoracic and cardiovascular surgery, S0022-5223(23)01099-1, 2023

19. Mimae T, Wakabayashi M, Sano Y, Sekino Y, Aokage K, Okada M, Watanabe S, Saji H, the Lung Cancer Surgical Study Group/Japan Clinical Oncology Group. Anatomical segmentectomy versus wedge resection for small (≤2 cm) peripheral non-small cell lung cancer in 80 or more aged elderly patients: a randomized phase III study (JCOG2109, AWESOME). Japanese Journal of Clinical Oncology, 53:1077–1081, 2023

20. Asamura H, Nishimura KK, Giroux DJ, Chansky K, Hoering A, Rusch V, Rami-Porta R. IASLC Lung Cancer Staging Project: The New Database to Inform Revisions in the Ninth Edition of the TNM Classification of Lung Cancer. Journal of thoracic oncology, 18:564-575, 2023

21. Takemura C, Imabayashi T, Furuse H, Uchimura K, Matsumoto Y, Tsuchida T, Watanabe SI. Thoracic SMARCA4-deficient undifferentiated tumor diagnosed by transbronchial mediastinal cryobiopsy: A case report. Thoracic cancer, 14:953-957, 2023

22. Aokage K, Suzuki K, Saji H, Wakabayashi M, Kataoka T, Sekino Y, Fukuda H, Endo M, Hattori A, Mimae T, Miyoshi T, Isaka M, Yoshioka H, Nakajima R, Nakagawa K, Okami J, Ito H, Kuroda H, Tsuboi M, Okumura N, Takahama M, Ohde Y, Aoki T, Tsutani Y, Okada M, Watanabe SI. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial. The Lancet. Respiratory medicine, 11:540-549, 2023

23. Higashiyama M, Motoi N, Yotsukura M, Yoshida Y, Nakagawa K, Yagishita S, Shirasawa M, Yoshida T, Shiraishi K, Kohno T, Ohe Y, Watanabe SI. Clinicopathological characteristics and molecular analysis of lung cancer associated with ciliated muconodular papillary tumor/bronchiolar adenoma. Pathology international, 73:188-197, 2023

24. Fujii H, Yamada Y, Yamamura K, Ishida Y, Tsujimura M, Matsumoto K, Tanaka S, Date H, Nishikawa T, Yoshida Y, Kashima J, Yatabe Y, Ogawa S, Marx A, Ulbright TM, Haga H. A case of vasculogenic mesenchymal tumor in the mediastinum: whole-exome sequencing reveals origin from pre-existing germ cell tumor. Virchows Archiv, 482:923-927, 2023

25. Shirasawa M, Yoshida T, Shiraishi K, Takigami A, Takayanagi D, Imabayashi T, Matsumoto Y, Masuda K, Shinno Y, Okuma Y, Goto Y, Horinouchi H, Yotsukura M, Yoshida Y, Nakagawa K, Tsuchida T, Hamamoto R, Yamamoto N, Motoi N, Kohno T, Watanabe SI, Ohe Y. Identification of inflamed-phenotype of small cell lung cancer leading to the efficacy of anti-PD-L1 antibody and chemotherapy. Lung cancer (Amsterdam, Netherlands), 179:107183, 2023

26. Akamine T, Nakagawa K, Ito K, Watanabe H, Yotsukura M, Yoshida Y, Yatabe Y, Kusumoto M, Watanabe SI. Role of fluorine-18-fluorodeoxyglucose positron emission tomography in selecting candidates for a minimally invasive approach for thymic epithelial tumour resection. Interdisciplinary cardiovascular and thoracic surgery, 36:ivad082, 2023

27. Shi J, Shiraishi K, Choi J, Matsuo K, Chen TY, Dai J, Hung RJ, Chen K, Shu XO, Kim YT, Landi MT, Lin D, Zheng W, Yin Z, Zhou B, Song B, Wang J, Seow WJ, Song L, Chang IS, Hu W, Chien LH, Cai Q, Hong YC, Kim HN, Wu YL, Wong MP, Richardson BD, Funderburk KM, Li S, Zhang T, Breeze C, Wang Z, Blechter B, Bassig BA, Kim JH, Albanes D, Wong JYY, Shin MH, Chung LP, Yang Y, An SJ, Zheng H, Yatabe Y, Zhang XC, Kim YC, Caporaso NE, Chang J, Ho JCM, Kubo M, Daigo Y, Song M, Momozawa Y, Kamatani Y, Kobayashi M, Okubo K, Honda T, Hosgood DH, Kunitoh H, Patel H, Watanabe SI, Miyagi Y, Nakayama H, Matsumoto S, Horinouchi H, Tsuboi M, Hamamoto R, Goto K, Ohe Y, Takahashi A, Goto A, Minamiya Y, Hara M, Nishida Y, Takeuchi K, Wakai K, Matsuda K, Murakami Y, Shimizu K, Suzuki H, Saito M, Ohtaki Y, Tanaka K, Wu T, Wei F, Dai H, Machiela MJ, Su J, Kim YH, Oh IJ, Lee VHF, Chang GC, Tsai YH, Chen KY, Huang MS, Su WC, Chen YM, Seow A, Park JY, Kweon SS, Chen KC, Gao YT, Qian B, Wu C, Lu D, Liu J, Schwartz AG, Houlston R, Spitz MR, Gorlov IP, Wu X, Yang P, Lam S, Tardon A, Chen C, Bojesen SE, Johansson M, Risch A, Bickeböller H, Ji BT, Wichmann HE, Christiani DC, Rennert G, Arnold S, Brennan P, McKay J, Field JK, Shete SS, Le Marchand L, Liu G, Andrew A, Kiemeney LA, Zienolddiny-Narui S, Grankvist K, Johansson M, Cox A, Taylor F, Yuan JM, Lazarus P, Schabath MB, Aldrich MC, Jeon HS, Jiang SS, Sung JS, Chen CH, Hsiao CF, Jung YJ, Guo H, Hu Z, Burdett L, Yeager M, Hutchinson A, Hicks B, Liu J, Zhu B, Berndt SI, Wu W, Wang J, Li Y, Choi JE, Park KH, Sung SW, Liu L, Kang CH, Wang WC, Xu J, Guan P, Tan W, Yu CJ, Yang G, Sihoe ADL, Chen Y, Choi YY, Kim JS, Yoon HI, Park IK, Xu P, He Q, Wang CL, Hung HH, Vermeulen RCH, Cheng I, Wu J, Lim WY, Tsai FY, Chan JKC, Li J, Chen H, Lin HC, Jin L, Liu J, Sawada N, Yamaji T, Wyatt K, Li SA, Ma H, Zhu M, Wang Z, Cheng S, Li X, Ren Y, Chao A, Iwasaki M, Zhu J, Jiang G, Fei K, Wu G, Chen CY, Chen CJ, Yang PC, Yu J, Stevens VL, Fraumeni JF Jr, Chatterjee N, Gorlova OY, Hsiung CA, Amos CI, Shen H, Chanock SJ,. Genome-wide association study of lung adenocarcinoma in East Asia and comparison with a European population. Nature communications, 14:3043, 2023

28. Adachi M, Matsumoto Y, Furuse H, Uchimura K, Imabayashi T, Yotsukura M, Yoshida Y, Nakagawa K, Igaki H, Watanabe SI, Tsuchida T. Utility of the endobronchial Watanabe spigot for intractable cancer-related pneumothorax: a retrospective observational study. Japanese journal of clinical oncology, 53:829-836, 2023

29. Aoki K, Nishito Y, Motoi N, Arai Y, Hiraoka N, Shibata T, Sonobe Y, Kayukawa Y, Hashimoto E, Takahashi M, Fujii E, Nishizawa T, Fukuda H, Ohashi K, Arai K, Mizoguchi Y, Yoshida Y, Watanabe SI, Yamashita M, Kitano S, Sakamoto H, Nagata Y, Mitsumori R, Ozaki K, Niida S, Kanai Y, Hirayama A, Soga T, Maruyama T, Tsukada K, Yabuki N, Shimada M, Kitazawa T, Natori O, Sawada N, Kato A, Yoshida T, Yasuda K, Mizuno H, Tsunoda H, Ochiai A. Tumor-infiltrating Leukocyte Profiling Defines Three Immune Subtypes of NSCLC with Distinct Signaling Pathways and Genetic Alterations. Cancer research communications, 3:1026-1040, 2023

30. Matsuura Y, Mun M, Shintani Y, Okami J, Ito H, Ohtsuka T, Mori T, Watanabe SI, Chida M, Endo S, Nakanishi R, Kadokura M, Suzuki H, Miyaoka E, Yoshino I, Date H. Features of anaplastic lymphoma kinase rearrangement in early-stage lung cancer: Analysis of a nationwide Japanese database. Journal of surgical oncology, 128:916-924, 2023

31. Liu L, Aokage K, Chen C, Chen C, Chen L, Kim YH, Lee CY, Liu C, Liu CC, Nishio W, Suzuki K, Tan L, Tseng YL, Yotsukura M, Watanabe SI. Asia expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study. JTCVS open, 14:483-501, 2023

32. Muraoka Y, Yotsukura M, Yoshida Y, Nakagawa K, Shiraishi K, Kohno T, Yatabe Y, Watanabe SI. Dynamics of recurrence after curative resection of nonsmall cell lung cancer. Journal of surgical oncology, 128:1205-1212, 2023

33. Okumura M, Yoshino I, Funaki S, Okuda K, Watanabe SI, Tsuboi M, Shimizu K, Date H, Chen-Yoshikawa TF, Nakajima J, Toyooka S, Asamura H. Long-term outcomes following surgical treatment for thymic epithelial tumor in Japan and an analysis of prognostic factors based on the Japanese Association for Research on the Thymus nationwide database. Surgery today, 53:1247-1259, 2023

34. Igarashi T, Mazevet M, Yasuhara T, Yano K, Mochizuki A, Nishino M, Yoshida T, Yoshida Y, Takamatsu N, Yoshimi A, Shiraishi K, Horinouchi H, Kohno T, Hamamoto R, Adachi J, Zou L, Shiotani B. An ATR-PrimPol pathway confers tolerance to oncogenic KRAS-induced and heterochromatin-associated replication stress. Nature communications, 14:4991, 2023

35. Adachi H, Saito A, Shintani Y, Okami J, Ito H, Ohtsuka T, Mori T, Watanabe SI, Chida M, Endo S, Nakanishi R, Kadokura M, Suzuki H, Miyaoka E, Yoshino I, Date H, Japanese Joint Committee Of Lung Cancer Registry. Is adjuvant chemotherapy for completely resected p-stage IA (>2 cm) and stage IB non-small-cell lung cancer beneficial for elderly patients? A large, retrospective cohort study based on real-world data from Japan. Japanese journal of clinical oncology, 53:1191-1200, 2023

36. Shirasawa M, Yoshida T, Shiraishi K, Goto N, Yagishita S, Imabayashi T, Matsumoto Y, Masuda K, Shinno Y, Okuma Y, Goto Y, Horinouchi H, Yotsukura M, Yoshida Y, Nakagawa K, Naoki K, Tsuchida T, Hamamoto R, Yamamoto N, Motoi N, Kohno T, Watanabe SI, Ohe Y. Tumor microenvironment-mediated immune profiles and efficacy of anti-PD-L1 antibody plus chemotherapy stratified by DLL3 expression in small-cell lung cancer. British journal of cancer, 129:2003-2013, 2023

37. Haga Y, Sakamoto Y, Kajiya K, Kawai H, Oka M, Motoi N, Shirasawa M, Yotsukura M, Watanabe SI, Arai M, Zenkoh J, Shiraishi K, Seki M, Kanai A, Shiraishi Y, Yatabe Y, Matsubara D, Suzuki Y, Noguchi M, Kohno T, Suzuki A. Whole-genome sequencing reveals the molecular implications of the stepwise progression of lung adenocarcinoma. Nature communications, 14:8375, 2023