Objectives To identify the clinicopathological features of malignant urachal tumor in Japan, and analyze the 5‐year overall survival of malignant urachal tumor patients. Methods We used the hospital‐based cancer registry data to extract malignant urachal tumor cases that were diagnosed in 2008–2009 and 2012–2015, histologically confirmed, and received the first course of treatment. We analyzed the 5‐year overall survival using the 2008–2009 cohort’s data. Results We identified 456 patients, and malignant urachal tumor accounted for 0.4% of all malignant bladder cancers. The median age was 61 years (range 2–97), and 66% were men. The most common histology was adenocarcinoma (80%), followed by urothelial carcinoma (11%) and squamous cell carcinoma (3%). The proportions of patients were: 19% Ta/Tis/T1N0M0, 55% T2–3N0M0, 13% T4/N+ and 13% M+. Regarding the initial treatment, the proportions of surgery alone were 79% and 33% in cases of T3 or less N0M0 and T4/N+, respectively. The proportion of combination therapy including surgery and chemotherapy were 13% and 44% in T2–3N0M0 and T4/N+, respectively. Radiation therapy was not common at any stage. In the 2008–2009 cohort, the 5‐year overall survival rate in Ta/Tis/T1N0M0, T2–3N0M0, T4/N+ and M+ were 60%, 64%, 63% and 12%, respectively. Conclusions Malignant urachal tumors are quite rare in Japan, and most of those without metastasis are likely to be treated by surgery alone, even at advanced stages. A standard of care must be established for malignant urachal tumor patients at advanced stages or with metastasis, as the prognosis of these patients can be poor.
To evaluate fertility and use of reproductive technology of testicular cancer survivors in a multi-institutional, cross-sectional study. Methods: This study recruited testicular cancer survivors who were followed after treatment for testicular cancer at eight high-volume institutions between 2018 and 2019. The participants completed the questionnaires on marital status, fertility and use of reproductive technology. Results: A total of 567 testicular cancer survivors, with a median age of 43 years, responded to the questionnaire. Chemotherapy was given to 398 survivors, including three cycles of cisplatin-based chemotherapy in 106 patients and four cycles in 147 patients. Among 153 survivors who attempted sperm cryopreservation, 133 (87%) could preserve sperm. Of the 28 survivors whose cryopreserved sperm was used, 17 (61%) fathered children. Of the 72 survivors who fathered children without the use of cryopreserved sperm, 59 (82%) fathered naturally. Whereas 33 (20%) of 169 survivors treated without chemotherapy fathered children without using cryopreserved sperm, 39 (10%) of 398 treated with chemotherapy fathered children (P < 0.05). Furthermore, the paternity rate was 12% and 5% in testicular cancer survivors with three and four cycles of cisplatin-based chemotherapy, respectively (P < 0.05). However, of 121 survivors who wanted to have children, 14 (12%) received counseling about infertility treatment. Conclusions: Testicular cancer survivors preserving their sperm have a higher paternity rate after chemotherapy, especially after four cycles, than those not using cryopreserved sperm. Physicians who give chemotherapy for testicular cancer need to take particular care not only with respect to recurrence of testicular cancer, but also to post-treatment fertility.
Background: Urological education is as important as surgical training for undergraduates. However, students in undergraduate medical schools have less exposure to urology as their curriculum focuses more on clinical skills, particularly community-based healthcare for a super-aging society. This study aimed to evaluate whether urology-related hands-on training could increase the interest of undergraduate medical students in urology. Methods: A 1-day elective program in urological surgery at the University of Tsukuba, particularly in robotic, laparoscopic, and endoscopic surgeries, was offered to 85 fourth-year medical students from 2018 to 2020, prior to their clinical clerkship. The average age of the participants was 22 (range: 21-25) years. We used a scoring system that comprised 1-5 Likert-type items to assess training activity, interest in surgery, and interest in urology before and after the course. Results: Before attending the program, the average scores of interest in urology were 3.53 in 2018, 3.15 in 2019, and 3.00 in 2020. The scores in surgery increased after the program; however, this was not significantly different from scores prior to the program. However, the average interest scores in urology were significantly increased to 3.91 ± 0.63 ( P < .05), 3.88 ± 0.58 ( P < .01), and 4.00 ± 0.61 ( P < 0.01) in 2018, 2019, and 2020, respectively. Total likely scores of this program in 2018, 2019, and 2020 were 4.59, 4.76, and 4.88, respectively, indicating a motivation to study surgery and urology during clinical clerkship. Conclusions: Urological hands-on training facilitated interest in urology in medical students prior to their clinical clerkship.
ObjectivesTo identify the prognosis of patients with non‐urothelial carcinoma of the upper urinary tract and compare it with that of patients with urothelial carcinoma.MethodsWe used hospital‐based cancer registry data in Japan to extract histologically confirmed non‐urothelial carcinoma and urothelial carcinoma cases of the upper urinary tract diagnosed in 2008–2009. We estimated the 5‐year overall survival by a Kaplan–Meier analysis. The Cox proportional hazards regression analysis was used to evaluate prognostic factors.ResultsA total of 2567 upper urinary tract cancer patients with confirmed histological subtypes were identified. The most common histology of non‐urothelial carcinoma was squamous cell carcinoma (n = 88, 3.4%) followed by adenocarcinoma (n = 33, 1.3%) and small cell carcinoma (n = 10, 0.4%). The proportion of advanced stage in the squamous cell carcinoma patients was significantly higher than that in the urothelial carcinoma patients (P = 0.003). In stage IV, the proportion of patients who received a combination of surgery + chemotherapy in the urothelial carcinoma group was higher than that in the non‐urothelial carcinoma group (34% vs 16%, respectively). The 5‐year overall survival rates of the non‐urothelial carcinoma patients at stages I–III and stage IV were significantly worse than those of the urothelial carcinoma patients (P = 0.003, P < 0.001, respectively). In multivariate analyses, age ≥73 years, advanced stage (stage IV), tumor location (ureter) and the presence of non‐urothelial carcinoma histology were independent poor prognosis factors.ConclusionThe prognosis of non‐urothelial carcinoma patients is worse than that of urothelial carcinoma patients, especially for non‐urothelial carcinoma patients at stage IV. More effective systemic therapies are required to improve these patients’ oncological outcomes.
Objective To identify the clinicopathological features of adrenal malignancies and analyze the prognoses of patients with adrenal cortical carcinoma (ACC) and malignant pheochromocytoma (MPCC). Patients and methods We used a hospital‐based cancer registry data in Japan to extract cases of adrenal malignancies that were histologically confirmed, diagnosed, and initially treated from 2012–2015. For survival analysis, we used data from the 2008–2009 cohort to estimate 5‐year overall survival (OS) by the Kaplan–Meier method. Results A total of 989 adrenal malignancies were identified in the 2012–2015 cohort. The most common histologies were ACC (26.4%), diffuse large B‐cell lymphoma (DLBCL; 25.4%), neuroblastoma (22.2%), and MPCC (11.9%). While most ACC and MPCC patients were in their 60s, DLBCL patients accounted for 61.5% of adrenal malignancies in the over‐70 cohort. Among ACC patients with clinical staging data, 46.3% of patients were stage IV. Although surgery was a chief strategy for all stages, younger patients tended to receive combination therapy, including surgery and chemotherapy or hormone therapy. In the 2008–2009 cohort, the 5‐year OS rates of ACC (n = 49) and MPCC (n = 23) patients were 56.2% and 86.4% while ACC patients without surgery had 1‐ and 2‐year OS rates of 25.0% and 12.5%. Conclusion In Japan, DLBCL accounted for the majority of adrenal malignancies in older patients. Despite advanced staging, ACC patients were mainly treated with surgery and their prognosis was not satisfactory. Such epidemiological data may be useful in considering initial management strategies.
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