基本情報
- 所属
- 自治医科大学 消化器外科 教授
- 学位
- 医学博士(東京大学)
- J-GLOBAL ID
- 201801007452437948
- researchmap会員ID
- B000314953
Professor of Jichi Medical University
Department of Surgical Oncology
Research field is Tumor Biology and main clinical work is the treatment of peritoneal metastasis of gastric cancer (intraperitoneal chemotherapy).
Department of Surgical Oncology
Research field is Tumor Biology and main clinical work is the treatment of peritoneal metastasis of gastric cancer (intraperitoneal chemotherapy).
研究分野
1論文
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World Journal of Surgery 2024年6月24日Abstract Background Osteopenia reflects frailty and has been shown to be associated with outcomes in cancer patients. This study was undertaken to examine whether osteopenia is an independent prognostic factor in patients with esophageal cancer after resection. Methods A total of 214 patients who underwent surgery for esophageal cancer were analyzed retrospectively. Bone mineral density (BMD) of the 11th thoracic vertebra was measured by computed tomography scan, and patients classified into osteopenia and normal BMD groups with BMD <160 Hounsfield units as the cutoff. Clinicopathological data and prognosis were analyzed. Results The 5‐year survival rate was 55.4% for the osteopenia group and 74.7% for the normal BMD group with a significantly worse prognosis in the osteopenia group (p = 0.0080). In multivariable analysis, osteopenia was a significant independent risk factor associated with overall survival (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.27–3.34, and p = 0.0151) along with R1/2 resection (HR 3.02, 95% CI 1.71–5.18, and p = 0.0002). Conclusion In patients with esophageal cancer undergoing resection, osteopenia may be a surrogate marker for frailty and an independent predictor of prognosis.
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Cancers 16(11) 2087-2087 2024年5月30日Background: Osteopenia is a well-known risk factor for survival in patients with hepatocellular carcinoma; however, it is unclear whether osteopenia can apply to both genders and how osteopenia is associated with cancer progression. The aim of this study was to elucidate whether osteopenia predicts reduced survival in regression models in both genders and whether osteopenia is associated with the pathological factors associated with reduced survival. Methods: This study included 188 consecutive patients who underwent hepatectomy. Bone mineral density was assessed using computed tomography (CT) scan images taken within 3 months before surgery. Non-contrast CT scan images at the level of the 11th thoracic vertebra were used. The cutoff value of osteopenia was calculated using a threshold value of 160 Hounsfield units. Overall survival (OS) curves and recurrence-free survival (RFS) were constructed using the Kaplan–Meier method, as was a log-rank test for survival. The hazard ratio and 95% confidence interval for overall survival were calculated using Cox’s proportional hazard model. Results: In the regression analysis, age predicted bone mineral density. The association in females was greater than that in males. The OS and RFS of osteopenia patients were shorter than those for non-osteopenia patients. According to univariate and multivariate analyses, osteopenia was an independent risk factor for OS and RFS. The sole pathological factor associated with osteopenia was microvascular portal vein invasion. Conclusion: Models suggest that osteopenia may predict decreased OS and RFS in patients undergoing resection of hepatocellular carcinoma due to the mechanisms mediated via microvascular portal vein invasion.
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Scientific Reports 14(1) 2024年2月26日Abstract Intestinal adaptation does not necessarily recover absorptive capacity in short bowel syndrome (SBS), sometimes resulting in intestinal failure-associated liver disease (IFALD). Additionally, its therapeutic options remain limited. Polyamines (spermidine and spermine) are known as one of the autophagy inducers and play important roles in promoting the weaning process; however, their impact on intestinal adaptation is unknown. The aim of this study was to investigate the impact of polyamines ingestion on adaptation and hepatic lipid metabolism in SBS. We performed resection of two-thirds of the small intestine in male Lewis rats as an SBS model. They were allocated into three groups and fed different polyamine content diets (0%, 0.01%, 0.1%) for 30 days. Polyamines were confirmed to distribute to remnant intestine, whole blood, and liver. Villous height and number of Ki-67-positive cells in the crypt area increased with the high polyamine diet. Polyamines increased secretory IgA and mucin content in feces, and enhanced tissue Claudin-3 expression. In contrast, polyamines augmented albumin synthesis, mitochondrial DNA copy number, and ATP storage in the liver. Moreover, polyamines promoted autophagy flux and activated AMP-activated protein kinase with suppression of lipogenic gene expression. Polyamines ingestion may provide a new therapeutic option for SBS with IFALD.
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Annals of surgical oncology 31(2) 735-743 2024年2月BACKGROUND: Intraperitoneal chemotherapy is promising for gastric cancer with peritoneal metastasis. Although a phase III study failed to show a statistically significant superiority of intraperitoneal paclitaxel combined with S-1 and intravenous paclitaxel, the sensitivity analysis suggested clinical efficacy. Thus, attempts to combine intraperitoneal paclitaxel with other systemic therapies with higher efficacy have been warranted. We sought to explore the efficacy of intraperitoneal paclitaxel with S-1 and cisplatin. PATIENTS AND METHODS: Gastric cancer patients with peritoneal metastasis were enrolled in the phase II trial. In addition to the established S-1 and cisplatin regimen every 5 weeks, intraperitoneal paclitaxel was administered on days 1, 8, and 22 at a dose of 20 mg/m2. The primary endpoint was overall survival rate at 1 year after treatment initiation. Secondary endpoints were progression-free survival and toxicity. RESULTS: Fifty-three patients were enrolled and fully evaluated for efficacy and toxicity. The 1-year overall survival rate was 73.6% (95% confidence interval 59.5-83.4%), and the primary endpoint was met. The median survival time was 19.4 months (95% confidence interval, 16.1-24.6 months). The 1-year progression-free survival rate was 49.6% (95% confidence interval, 34.6-62.9%). The incidences of grade 3/4 hematological and non-hematological toxicities were 43% and 47%, respectively. The frequent grade 3/4 toxicities included neutropenia (25%), anemia (30%), diarrhea (13%), and anorexia (17%). Intraperitoneal catheter and implanted port-related complications were observed in four patients. There was one treatment-related death. CONCLUSIONS: Intraperitoneal paclitaxel combined with S-1 and cisplatin is well tolerated and active in gastric cancer patients with peritoneal metastasis.
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Journal of thoracic disease 16(1) 391-400 2024年1月30日BACKGROUND: Adjuvant nivolumab therapy has become the standard therapy for patients with localized advanced esophageal cancer with non-pathological complete response after neoadjuvant chemoradiotherapy followed by curative surgery. However, the necessity of this therapy for patients after neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil (DCF) regimen followed by surgery is unclear, and the prognosis of grouping based on the presence or absence of pathological tumor and lymph node findings has not been analyzed. Therefore, our study aimed to address these questions. METHODS: This retrospective cohort study included patients with cT1N1-3M0 and cT2-3N0-3M0 esophageal cancer according to the Japanese Classification of Esophageal Cancer, 11th edition, who received NAC with DCF followed by curative surgery between 2008 and 2020 at Jichi Medical University Hospital. We divided patients with ypT0-3N0-3M0 into four histological groups, namely ypT0N0, ypT+N0, ypT0N+, and ypT+N+, and we evaluated overall survival as the primary outcome and the prognostic relationship of lymph node metastasis as the secondary outcome. RESULTS: A total of 101 patients were included in this study. Kaplan-Meier analysis showed that the curves of the ypT0N0 and ypT+N0 groups were almost identical, while they differed from the other two groups. The hazard ratio of ypN+ was 4.44 (95% confidence interval: 2.03-9.71; P<0.001). CONCLUSIONS: The prognosis of the ypT+N0 group after NAC with DCF followed by surgery was similar to that of pathological complete remission. Grouping patients according to pathological lymph node status is a reasonable predictor of prognosis.
MISC
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日本外科学会雑誌 108 308-308 2007年3月10日
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日本外科学会雑誌 108(2) 364-364 2007年3月10日
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Surgery Frontier 14(1) 20-23 2007年3月ラウス肉腫ウイルスのもつ癌遺伝子srcと非常によく似た塩基配列が、正常のゲノムに存在することが明らかとなり、これらの研究から、これがリン酸化反応を触媒するプロテインキナーゼ活性を有し、シグナル伝達に関与することがわかった。すなわち、癌遺伝子は正常のシグナル伝達を行っており、決して特別な機能を有していたわけではなかった。一方、網膜芽細胞腫や家族性大腸ポリポーシスなどの遺伝病から、癌抑制遺伝子である、Rb、APCがクローニングされ、次いでp53が癌抑制遺伝子であることが明らかとなった。これらの解析から、癌抑制遺伝子は細胞増殖、アポトーシス、細胞周期、浸潤など正常細胞における重要な機能に関与していることがわかってきた。以上より癌遺伝子、癌抑制遺伝子は、正常細胞のもつ機能に深くかかわっていることが明らかとなった。むしろ、シグナル伝達、細胞周期やアポトーシスなどの機能は癌研究とともに進んできたともいえる。(著者抄録)
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外科 68(8) 887-891 2006年8月脂肪由来ホルモンレプチンおよびその受容体Ob-Rは,ヒト乳癌細胞に発現が認められ,その発現増強は血行性転移の有無,患者予後と有意な相関を示す.レプチンが細胞増殖,浸潤などに促進的な作用を有することと合せて,レプチン,Ob-Rの発現が乳癌の新たなバイオマーカーであることが判明した(著者抄録)
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日本消化器外科学会雑誌 39(7) 976-976 2006年7月1日
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日本消化器外科学会雑誌 39(7) 1061-1061 2006年7月1日
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日本外科学会雑誌 107(2) 61-61 2006年3月5日
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癌と化学療法 32(11) 1576-1577 2005年10月H2-blockerであるシメチジンは細胞性免疫の賦活作用を有することが報告されている.一方,NKT細胞は抗腫瘍免疫において重要な役割を果たすことが確認され,近年,注目されている.今回われわれは,細胞性免疫全体に及ぼすシメチジンの影響に着目し検討を行った.健常人ボランティア6人にシメチジン800mg/dayを7日間連続投与した.投与前,投与後1,3,5,7日目に採血し,白血球数およびその分画の計測,末梢血細胞分画の推移の検討を行った.血算では白血球増加傾向が認められ,それは主に好中球およびCD3+Tリンパ球の増加によるものであり,さらにはTリンパ球のうち,特にCD4+細胞の増加が認められた.一方,NK細胞の割合は減少しており,NKT細胞の割合は変化しなかった.シメチジンは特異的な細胞性免疫を亢進することが確認され,抗腫瘍免疫の賦活剤としての応用性が示唆された(著者抄録)
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日本消化器外科学会雑誌 38(7) 1182-1182 2005年7月1日
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日本消化器外科学会雑誌 38(7) 1084-1084 2005年7月1日
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日本外科学会雑誌 106 368-368 2005年4月5日
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皮膚科の臨床 47(2) 177-181 2005年2月82歳女.レイノー現象が30年前に出現し,2年前より手指の腫脹,足趾の潰瘍,壊死がみられ,抗セントロメア抗体陽性で,強指症があり,皮膚硬化も認め,生検にてlimited typeの汎発性強皮症と診断されていた.今回,食欲不振,全身倦怠感がみられた後,胸部苦悶感および腹部,心窩部に疼痛が出現した.血液検査にてWBC,BUN,アミラーゼの上昇を,血液ガスにて代謝性アシドーシスを認めた.入院後CKおよびCK-MBは上昇し,心電図にてV2〜V6のST低下,心エコーにて下後壁の壁運動の低下が見られた.緊急胸腹部CTでは上行〜下行結腸が拡張し,上腸間膜動脈に血栓はみられなかったが,狭小化を認めた.非閉塞性腸管壊死を疑い緊急開腹術を施行したところ,回腸末端部〜S状結腸にかけての壊死,および空腸を中心とする斑状の壊死を認めた.また,胆嚢の壊死も疑われた.その後心電図にてV1〜V4のST上昇,冠動脈造影にてLADの100%狭窄を認めたため,急性心筋梗塞と診断し緊急PTCAを施行した.以後,心房細動を繰り返したが,徐々に循環動態,意識レベルともに改善した.経過中,手指のレイノー現象が増悪した
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手術 58(9) 1511-1514 2004年8月結腸憩室炎に起因すると考えられた後腹膜膿瘍2例(63歳男,60歳女)にドレナージ手術を施行し,良好な結果を得た.2症例は共に基礎疾患があり,全身状態の悪化した患者であったが,手術により早期に全身状態の改善を図ることができた.手術侵襲も高度なものとは考えられず,重症例に対しても手術的膿瘍ドレナージは有用であると思われた
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手術 58(4) 609-612 2004年4月65歳男.便秘を認め直腸壁外腫瘍が疑われ,精査目的で紹介された.骨盤部CT検査,MRI検査,選択的動脈造影検査で直腸後壁に腫瘤を認め,CTガイド下経皮的針生検ではuncommitted typeのgastrointestinal stromal tumor(GIST)と診断された.直腸原発GISTの診断により,腹会陰式直腸切断術を施行した.摘出標本は,薄い被膜で覆われた7.5cm大の淡褐色調の腫瘍で,粘膜面は平滑で腫瘍の露出なく肛門側は歯状線にかかっていた.組織学的検査では針生検と同様にGISTの所見であった.術後19ヵ月経過の現在,再発はない
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日本外科学会雑誌 105 398-398 2004年3月15日
講演・口頭発表等
1196-
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