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What ' s known on the subject? and What does the study add?Radical cystectomy remains associated with comparatively high perioperative morbidity and mortality, despite improvements in surgical techniques and perioperative care. At present, most studies on the complications associated with open radical cystectomy were derived from Western academic high-volume centres, and data from Japan and other Asian countries were very limited.Using the modifi ed Clavien grading system and 11 category grouping reported from MSKCC, we observed that 68% of patients experienced at least one complication within 90 days of surgery, and 17% of patients experienced major complications (90-day mortality rate = 2%), which were compatible with reports from Western high-volume centres. As far as we know, our report is the largest one regarding perioperative morbidity and mortality in Asian patients who underwent radical cystectomy. OBJECTIVE• To determine the type, incidence and severity of 90-day morbidity after radical cystectomy in our institution and our affi liated hospitals in accordance with a standard reporting methodology. A t present, most studies on complications associated with open radical cystectomy are derived from W estern academic high-volume centres and data from J apan and other A sian countries remain very limited. PATIENTS AND METHODS• The study comprised a retrospective multi-institutional study.• The records were reviewed of 928 patients who underwent open radical cystectomy between 1997 and 2010.• All complications within 90 days of surgery were categorized into 11 specifi c categories and graded in accordance with the modifi ed C lavien system.• Multivariate regression models were used to determine predictors of complications. RESULTS• A t least one complication was observed in 635 (68%) patients and a major (grade 3-5) complication was observed in 156 (17%) patients.• The most common complication categories were infectious (30%), gastrointestinal (26%), wound-related (21%) and genitourinary (15%).• The 30-day mortality rate was 0.8% and the 90-day mortality rate was 2%.• A multivariate regression model showed that previous cardiovascular comorbidity and type of urinary diversion (i.e. ileal conduit or neobladder) were signifi cant factors for any and major complications. CONCLUSIONS• Surgical complication-related radical cystectomy is signifi cant and both previous cardiovascular comorbidity and the type of urinary diversion were found to be signifi cant factors for any and major complications.• The 90-day mortality rate was 2%, which is compatible with reports from Western high-volume centres.

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The aims of the present study were to: (i) develop a clinically useful prognostic classification in Asian patients with metastatic renal cell carcinoma (RCC) by combining metastatic features with several pretreatment parameters; and (ii) evaluate the validity of this prognostic classification. Baseline characteristics and outcomes were collected for 361 patients who underwent interferon-a-based therapy between 1995 and 2005. Relationships between overall survival (OS) and potential prognostic factors were assessed using Cox's proportional hazard model. The predictive performance of the model was evaluated using bootstrap resampling procedures and by using an independent dataset obtained from randomly selected institutions. The predictive accuracy was measured using the concordance index (c-index). Four factors were identified as independent prognostic factors: time from initial diagnosis to treatment, anemia, elevated lactate dehydrogenase (LDH), and poor prognostic metastatic group (liver only, bone only, or multiple organ metastases). Each patient was assigned to one of three risk groups: favorable risk (none or one factor; n = 120), in which median OS was 51 months; intermediate risk (two factors; n = 101), in which median OS was 21 months; and poor risk (three or four factors; n = 102), in which median OS was 10 months. The c-index was 0.72 in the original dataset and 0.72 in 500 random bootstrap samples. In the independent dataset for external validation, the c-index was 0.73. Thus, the new prognostic classification is easily applicable for Asian patients with previously untreated metastatic RCC and should be incorporated into patient care, as well as clinical trials performed in Asia. (Cancer Sci 2012; 103: 1695-1700 W ith the advent of molecular targeted therapy, treatment for metastatic renal cell carcinoma (RCC) has changed markedly. At present, drugs that should be used for molecular targeted therapy are usually selected on the basis of the Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification.(1,2) This results from the fact that clinical trials of molecular targeted drugs, such as sunitinib and temsirolimus, have been performed by selecting subjects on the basis of this risk classification and their usefulness has been clarified. (3,4) In Japan, the MSKCC risk classification is widely used not only in clinical trials, but also in daily clinical practice.(5,6) However, whether this risk classification is useful for predicting outcomes in Japanese patients with metastatic RCC is not unclear. Recently, we performed a retrospective study on the MSKCC risk classification in patients with metastatic RCC and reported its applicability to Japanese patients.(7) However, when this risk classification was used in Japanese RCC patients, the percentage of patients in the poor risk group was high compared with that in Western series and the survival period of the poor risk group was twice as long in Japanese patients as that in patients in Western countries. (7,8) This may be because multiple organ me...

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BackgroundTo clarify the relationship between the probability of prostate cancer scaled using a 5-point Likert system and the biological characteristics of corresponding tumor foci.MethodsThe present study involved 44 patients undergoing 3.0-Tesla multiparametric MRI before laparoscopic radical prostatectomy. Tracing based on pathological and MRI findings was performed. The relationship between the probability of cancer scaled using the 5-point Likert system and the biological characteristics of corresponding tumor foci was evaluated.ResultsA total of 102 tumor foci were identified histologically from the 44 specimens. Of the 102 tumors, 55 were assigned a score based on MRI findings (score 1: n = 3; score 2: n = 3; score 3: n = 16; score 4: n = 11 score 5: n = 22), while 47 were not pointed out on MRI. The tracing study revealed that the proportion of >0.5 cm3 tumors increased according to the upgrade of Likert scores (score 1 or 2: 33 %; score 3: 68.8 %; score 4 or 5: 90.9 %, χ2 test, p < 0.0001). The proportion with a Gleason score >7 also increased from scale 2 to scale 5 (scale 2: 0 %; scale 3: 56.3 %; scale 4: 72.7 %; 5: 90.9 %, χ2 test, p = 0.0001). On using score 3 or higher as the threshold of cancer detection on MRI, the detection rate markedly improved if the tumor volume exceeded 0.5 cm3 (<0.2 cm3: 10.3 %; 0.2-0.5 cm3: 25 %; 0.5-1.0 cm3: 66.7 %; 1.0 < cm3: 92.1 %).ConclusionsEach Likert scale favobably reflected the corresponding tumor’s volume and Gleason score. Our observations show that “score 3 or higher” could be a useful threshold to predict clinically significant carcinoma when considering treatment options.