Annual Report 2024
Department of Urology
Yoshiyuki Matsui, Motokiyo Komiyama, Eijiro Nakamura, Yasuo Shinoda, Ayumu Matsuda, Aiko Maejima, Hiroyuki Fujimoto, Tomoya Okuno, Takahiro Kirisawa, Hiroki Hagimoto
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
Our department has transferred responsibility for pharmacotherapy to the Division of Medical Oncology and now focuses primarily on the surgical management of urological and retroperitoneal tumors. One physician from the Division of Medical Oncology holds a concurrent appointment in our department, thereby strengthening our clinical framework. In fiscal year 2024, we performed a total of 341 surgeries under anesthesiology management (Table 1). Standard surgical procedures for urological malignancies have been increasingly transitioned to robot-assisted techniques, with the introduction of the da Vinci SP system further driving the growth in robotic case volume. Conversely, the proportion of laparoscopic surgeries has shown a declining trend. Challenging conditions requiring multidisciplinary treatment—such as retroperitoneal sarcoma and advanced testicular cancer—have consistently accounted for 15–20% of annual surgical cases, supported by a well-established team-based approach in collaboration with other specialties. Notably, we also introduced robot-assisted surgery for retroperitoneal tumor resection, a distinctive feature of our department, and successfully performed the inaugural case with full attention to patient safety.
Table 1. Patient statistics: Major surgeries in 2024
Research Activities
With the aim of achieving minimally invasive yet highly precise surgical care, we have actively applied robot-assisted and laparoscopic techniques not only to standard procedures but also to extended surgeries for highly complicated diseases. Robot-assisted retroperitoneal tumor resection represents one such pioneering initiative. In the field of clinical research, we have advanced multi-institutional collaborative studies associated with the Japan Clinical Oncology Group (JCOG) and the Japan Urological Oncology Group (JUOG), as well as industry-sponsored clinical trials, and have disseminated our findings in international journals (Matsuda A, et al. BJU Int. 2024;134:207-218; Hagimoto H, et al. World J Urol. 2024 Dec 21;43:43). Furthermore, biomarker discovery studies utilizing a biobank system and surgical specimens have been approved by the institutional ethics committee and are progressing in collaboration with other institutions. In this domain, we have secured two Grants-in-Aid for Scientific Research, thereby strengthening our research infrastructure.
Clinical Trials
1) A randomized controlled phase III trial on continued or paused PD-1 pathway blockade for patients with advanced renal cell carcinoma (JCOG1905)
2) 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)
3) Current clinical features of kidney cancers in patients with VHL disease in Japan
4) A multicenter observational study on the patterns of skin toxicity associated with enfortumab vedotin
5) Multicenter observational study on the treatment of unresectable or metastatic urothelial carcinoma in the era of combination immunotherapy
6) Phase 2 Study of Belzutifan (MK-6482) in advanced pheochromocytoma/paraganglioma and other selected solid tumors
7) 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.
8) IMvigor011: A Phase III, randomized, double-Blind, placebo-controlled study of atezolizumab versus placebo in participants with high-risk muscle-invasive bladder cancer (MIBC) who are ctDNA-positive after cystectomy
9) A phase III, randomized, open label, controlled, multi center, global study of first line MEDI4736 (durvalumab) monotherapy and MEDI4736 (durvalumab) in combination with tremelimumab versus standard of care chemotherapy in patients with unresectable stage iv urothelial cancer
Education
In addition to training urology residents, our department accepts residents from the departments of surgery and gynecology, providing them with specialized instruction. For laparoscopic and robot-assisted procedures, we have promoted a structured, stepwise training program that prioritizes safety while enhancing the technical skills of junior surgeons. Furthermore, we have actively encouraged resident participation in clinical research and provided opportunities for presentations at academic conferences and for the publication of scholarly 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 2024
Journal
1. Sekita T, Asano N, Kubo T, Totsuka H, Mitani S, Hattori N, Yoshida A, Kobayashi E, Komiyama M, Ushijima T, Nakayama R, Nakamura M, Kawai A, Ichikawa H. Early separation and parallel clonal selection of dedifferentiated and well-differentiated components in dedifferentiated liposarcoma. Neoplasia (New York, N.Y.), 59:101074, 2025
2. Matsuda A, Taoka R, Miki J, Saito R, Fukuokaya W, Hatakeyama S, Kawahara T, Fujii Y, Kato M, Sazuka T, Sano T, Urabe F, Kashima S, Naito H, Murakami Y, Miyake M, Daizumoto K, Matsushita Y, Hayashi T, Inokuchi J, Sugino Y, Shiga K, Yamaguchi N, Iio H, Yasue K, Abe T, Nakanishi S, Matsumura M, Fujii M, Nishihara K, Matsumoto H, Tatarano S, Wada K, Sekito S, Maruyama R, Nishiyama N, Nishiyama H, Kitamura H, Matsui Y. Prognostic impact of histological discordance between transurethral resection and radical cystectomy. BJU international, 134:207-218, 2024
3. Imai T, Kojima Y, Shimoi T, Aiba H, Okuma HS, Saito A, Kita S, Yamamoto K, Maejima A, Nishikawa T, Sudo K, Noguchi E, Yoshida A, Matsui Y, Iwata S, Kobayashi E, Kawai A, Udagawa R, Fujiwara Y, Yonemori K. Predicting Trabectedin Efficacy in Soft Tissue Sarcoma: Inflammatory Biomarker Analysis. Anticancer research, 44:2125-2132, 2024
4. Kashihara T, Urago Y, Okamoto H, Takemori M, Nakayama H, Mikasa S, Nakaichi T, Iijima K, Chiba T, Kuwahara J, Nakamura S, Chang W, Matsui Y, Igaki H. A preliminary study on rectal dose reduction associated with hyaluronic acid implantation in brachytherapy for prostate cancer. Asian journal of urology, 11:286-293, 2024
5. Kirisawa T, Okuno T, Hagimoto H, Matsuda A, Maejima A, Shinoda Y, Nakamura E, Komiyama M, Fujimoto H, Matsui Y. Clinical characteristics and survival outcomes of elderly patients with de novo metastatic germ cell tumors. International journal of urology, 31:804-812, 2024
6. Tomida R, Takahashi M, Matsushita Y, Kojima T, Yamana K, Kandori S, Bando Y, Nishiyama N, Yamashita S, Taniguchi H, Monji K, Ishiyama R, Tatarano S, Masui K, Matsuda A, Kaneko T, Motoshima T, Shiraishi Y, Kira S, Murashima T, Hara H, Matsumura M, Kitamura H, Miyake H, Furukawa J. Comparison of Cabozantinib and Axitinib as Second-line Therapy After Nivolumab Plus Ipilimumab in Patients With Metastatic Clear Cell Renal Cell Carcinoma: A Comparative Analysis of Retrospective Real-world Data. Clinical genitourinary cancer, 22:102094, 2024
7. Miki J, Fukuokaya W, Taoka R, Saito R, Matsui Y, Hatakeyama S, Kawahara T, Matsuda A, Kawai T, Kato M, Sazuka T, Sano T, Urabe F, Kashima S, Naito H, Murakami Y, Nishiyama N, Nishiyama H, Kitamura H, Kimura T. Oncological outcomes of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer: A nationwide multi-institutional study. International journal of urology, 31:1009-1016, 2024
8. Osawa T, Sasaki K, Machida R, Matsumoto T, Matsui Y, Kitamura H, Nishiyama H. Real-world treatment trends for patients with advanced prostate cancer and renal cell carcinoma and their cost-a survey in Japan. Japanese journal of clinical oncology, 54:1062-1070, 2024
9. Kimura S, Sone M, Sugawara S, Itou C, Ozawa M, Sato T, Matsui Y, Arai Y, Kusumoto M. Safety of propofol sedation administered by interventional radiologists for radiofrequency ablation in patients with hepatocellular carcinoma. Japanese journal of radiology, 42:1290-1297, 2024
10. Uchihara M, Tanabe A, Kojima Y, Shimoi T, Maeshima AM, Umamoto K, Shimomura A, Shimizu C, Yamazaki Y, Nakamura E, Matsui Y, Takemura N, Miyazaki H, Sudo K, Yonemori K, Kajio H. Immunohistochemical Profiling of SSTR2 and HIF-2α with the Tumor Microenvironment in Pheochromocytoma and Paraganglioma. Cancers, 16:2191, 2024
11. Sakamoto S, Sato K, Kimura T, Matsui Y, Shiraishi Y, Hashimoto K, Miyake H, Narita S, Miki J, Matsumoto R, Kato T, Saito T, Tomida R, Shiota M, Joraku A, Terada N, Suekane S, Kaneko T, Tatarano S, Yoshio Y, Yoshino T, Nishiyama N, Kawakami E, Ichikawa T, Kitamura H. PSA doubling time 4.65 months as an optimal cut-off of Japanese nonmetastatic castration-resistant prostate cancer. Scientific reports, 14:15307, 2024
12. Tanegashima T, Shiota M, Kimura T, Takamatsu D, Matsui Y, Yokomizo A, Saito R, Morizane S, Miyake M, Tsutsumi M, Yamamoto Y, Tashiro K, Tomida R, Edamura K, Narita S, Yamaguchi T, Kasahara T, Hashimoto K, Kato M, Yoshino T, Akamatsu S, Matsukawa A, Kaneko T, Matsumoto R, Joraku A, Kato M, Saito T, Kato T, Tatarano S, Sakamoto S, Kanno H, Terada N, Nishiyama N, Kitamura H, Eto M. Prognosis based on postoperative PSA levels and treatment in prostate cancer with lymph node involvement. International journal of clinical oncology, 29:1586-1593, 2024
13. Fukuokaya W, Miki J, Taoka R, Saito R, Matsui Y, Hatakeyama S, Kawahara T, Matsuda A, Kawai T, Kato M, Sazuka T, Sano T, Urabe F, Kashima S, Naito H, Murakami Y, Nishiyama N, Nishiyama H, Kitamura H, Kimura T. Development and validation of a model to predict the outcomes of radical cystectomy in patients with bladder cancer. International journal of urology, 31:1414-1422, 2024
14. Fujita K, Matsushita Y, Toyoda S, Kojima T, Yamashita S, Taniguchi H, Monji K, Ishiyama R, Tatarano S, Masui K, Nakamura E, Kaneko T, Kitano G, Motoshima T, Shiraishi, Kira S, Murashima T, Hara H, Matsumura, Nishiyama N, Miyake H, Kitamura H, Uemura H. The efficacy of second-line tyrosine kinase inhibitor for patients with metastatic non-clear cell renal cell carcinoma following first-line immune-oncology combination therapy. World journal of urology, 42:536, 2024
15. Kato M, Taoka R, Miki J, Saito R, Fukuokaya W, Matsui Y, Yamamoto S, Matsue T, Hatakeyama S, Kawahara T, Matsuda A, Kawai T, Sazuka T, Sano T, Urabe F, Kashima S, Naito H, Murakami Y, Miyake M, Daizumoto K, Matsushita Y, Hayashi T, Inokuchi J, Sugino Y, Shiga K, Yamaguchi N, Yamamoto S, Yasue K, Abe T, Nakanishi S, Hashine K, Fujii M, Nishihara K, Matsumoto H, Tatarano S, Wada K, Sekito S, Maruyama R, Nishiyama N, Nishiyama H, Kitamura H, Uchida J. Reproductive organ involvement in women undergoing radical cystectomy for urothelial bladder cancer: a nationwide multicenter study. International journal of clinical oncology, 29:1937-1945, 2024
16. Kirisawa T, Maeshima AM, Okuno T, Matsuda A, Matsui Y. Widespread benign HNF1β-positive solid nests from the urethral diverticulum to the bladder neck: Is it a mesonephric remnant? Pathology international, 74:714-717, 2024
17. Ogura J, Yamanoi K, Ishida K, Nakamura E, Ito S, Aoyama N, Nakanishi Y, Menju T, Kawaguchi K, Hosoe Y, Taki M, Murakami R, Yamaguchi K, Hamanishi J, Mandai M. A stearate-rich diet and oleate restriction directly inhibit tumor growth via the unfolded protein response. Experimental & molecular medicine, 56:2659-2672, 2024
18. Hagimoto H, Kubota M, Matsui Y, Sumiyoshi T, Saito R, Segawa T, Fukuzawa S, Mitsumori K, Yoshida T, Akao T, Sekine Y, Negoro H, Kurahashi R, Shimatani K, Sawada A, Akamatsu S, Kobayashi T, Goto T, Dai-Cad TDCAD. Impact of neurovascular bundle preservation on biochemical recurrence after robot-assisted radical prostatectomy for high-risk prostate cancer. World journal of urology, 43:43, 2024
19. Kirisawa T, Maeshima A, Kikkawa N, Nakamura E, Shimoi T, Maejima A, Imai T, Hagimoto H, Okuno T, Matsuda A, Shinoda Y, Komiyama M, Fujimoto H, Yonemori K, Matsui Y. Prognostic factors for patients with urachal carcinoma undergoing radical surgery: risk stratification for future prospects of precision oncology. JU Open Plus, 2:e00096, 2024