Yokota T.,Aichi Cancer Center Hospital |
Ura T.,Aichi Cancer Center Hospital |
Shibata N.,Aichi Cancer Center Hospital |
Takahari D.,Aichi Cancer Center Hospital |
And 7 more authors.
British Journal of Cancer | Year: 2011
Background: Activating mutation of KRAS and BRAF are focused on as potential prognostic and predictive biomarkers in patients with colorectal cancer (CRC) treated with anti-EGFR therapies. This study investigated the clinicopathological features and prognostic impact of KRAS/BRAF mutation in advanced and recurrent CRC patients.Method:Patients with advanced and recurrent CRC treated with systemic chemotherapy (n=229) were analysed for KRAS/BRAF genotypes by cycleave PCR. Prognostic factors associated with survival were identified by univariate and multivariate analyses using the Cox proportional hazards model. Results: KRAS and BRAF mutations were present in 34.5% and 6.5% of patients, respectively. BRAF mutated tumours were more likely to develop on the right of the colon, and to be of the poorly differentiated adenocarcinoma or mucinous carcinoma, and peritoneal metastasis. The median overall survival (OS) for BRAF mutation-positive and KRAS 13 mutation-positive patients was 11.0 and 27.7 months, respectively, which was significantly worse than that for patients with wild-type (wt) KRAS and BRAF (40.6 months) (BRAF; HR=4.25, P<0.001, KRAS13; HR=2.03, P=0.024). After adjustment for significant features by multivariate Cox regression analysis, BRAF mutation was associated with poor OS (HR=4.23, P=0.019). Conclusion: Presence of mutated BRAF is one of the most powerful prognostic factors for advanced and recurrent CRC. The KRAS13 mutation showed a trend towards poor OS in patients with advanced and recurrent CRC. © 2011 Cancer Research UK All rights reserved.
Kawaguchi A.,Health Science University |
Matsunaga Y.,Nagoya Kyoritsu Hospital |
Otsuka T.,Daido Hospital |
Suzuki S.,Health Science University
Radiological Physics and Technology | Year: 2014
Our aim in this study was to investigate the incident air kerma (IAK) and average glandular dose (AGD) for polymethylmethacrylate (PMMA) phantoms and patient breasts for each thickness by use of digital mammography units, and to determine the correlation between phantom and patient measurements. An additional aim was to calculate the numerical value of the diagnostic reference level (DRL) for digital mammography in Japan based on the AGD from patient measurements. Patient-based IAK and AGD values were calculated for 300 patients who underwent mammographic examinations at three institutions. On examination of a 40-mm PMMA phantom, the IAK and the AGD were 7.89 and 1.84 mGy, respectively. The mean patient breast thickness was 37.6 mm, and the mean IAK and the AGD calculated from actual patient data for breast thicknesses between 40 mm and 50 mm were 8.91 and 2.08 mGy, respectively. Approximately 20% of the 300 patients had IAK >10 mGy. The distributions of patient-based IAK and AGD values were higher than the IAK and AGD values for the PMMA phantom. The patient dose with use of the PMMA phantom can be underestimated. The DRL was calculated from patient-based AGDs of the regular breast thickness as 2.0 mGy in Japan. © Japanese Society of Radiological Technology and Japan Society of Medical Physics 2013.
Kumada Y.,Matsunami General Hospital |
Nogaki H.,Matsunami General Hospital |
Ishii H.,Nagoya University |
Aoyama T.,Nagoya Kyoritsu Hospital |
And 2 more authors.
Journal of Vascular Surgery | Year: 2015
Objective Lower extremity bypass surgery has been widely performed to treat critical limb ischemia (CLI) in patients on hemodialysis (HD). However, the clinical outcome still remains unclear. We investigated the limb salvage rate after infrapopliteal bypass surgery in HD patients with CLI. Methods From April 2006 to January 2013, 226 patients with 236 limbs who electively underwent bypass surgery for treatment of CLI due to infrapopliteal disease were enrolled. Patients were grouped by those who were on HD (n = 177) and those who were not (n = 49). They were monitored for 5 years or until December 2013 if the follow-up period was <5 years. Amputation-free survival, defined as freedom from major amputation or all-cause death, was primarily evaluated. Incidence of reintervention was also analyzed. Results Ulcer/gangrene was present in 206 patients (91.2%), and 233 limbs (98.7%) were treated using autogenous vein. Age was younger (67 ± 9 vs 72 ± 9 years; P =.0011) and ulcer/gangrene was more prevalent (93.8% vs 81.6%, P =.0080) in HD patients than in non-HD patients. During the follow-up period (median, 28 months), 33 (14.6%) major amputations and 28 reinterventions (12.4%) occurred, and 65 patients (28.8%) died. The 5-year amputation-free survival rate was significantly lower in HD patients than in non-HD patients (43.6% vs 78.8%, P =.0033), and the adjusted hazard ratio (HR) for amputation or death for HD patients was 2.36 (95% confidence interval [CI], 1.13-4.92; P =.022). Compared with non-HD patients, the status of HD was similarly an independent risk of major amputation (72.4% vs 92.5%; adjusted HR, 4.36; 95% CI, 1.04-18.3; P =.045) and mortality (56.9% vs 83.2%; adjusted HR, 2.81; 95% CI, 1.30-6.09; P =.0085). However, freedom from reintervention was comparable between the two groups (84.3% vs 86.8%; P =.89). In HD patients, body mass index (HR, 0.86; 95% CI, 0.76-0.96; per 1 kg/m2 increase; P =.014) and C-reactive protein (HR, 1.06; 95% CI, 1.01-1.11; P =.014) independently predicted major amputation. Elevated C-reactive protein levels were also associated with death (HR, 1.04; 95% CI, 1.01-1.09; P =.047). Conclusions The clinical outcome after infrapopliteal bypass surgery was poorer in HD patients with CLI compared with non-HD patients. Malnutrition or chronic inflammation was associated with poor outcome in HD patients with CLI due to infrapopliteal occlusive disease. © 2015 Society for Vascular Surgery.
Soga Y.,Kokura Memorial Hospital |
Mii S.,Seitetsu Memorial Yahata Hospital |
Aihara H.,Kokura Memorial Hospital |
Okazaki J.,Kokura Memorial Hospital |
And 5 more authors.
Circulation Journal | Year: 2013
Background: The efficacy of stent-assisted endovascular therapy (EVT) in patients with critical limb ischemia (CLI) compared to bypass surgery (BSX) remains unclear. Methods and Results: This study was performed as a multicenter retrospective registry. Between January 2004 and December 2009, 460 CLI patients (460 first treated limbs) who underwent BSX (237 patients) or EVT (223 patients) for de novo infrainguinal lesions were identified retrospectively and analyzed. The main endpoints of this study were amputation-free survival (AFS), overall survival, limb salvage rate and freedom from major adverse limb events (MALE; includes any repeat revascularization and major amputation). Three-year AFS, limb salvage rate and overall survival were not different between the BSX and EVT groups (60.3% vs. 58.0%, P=0.43; 85.1% vs. 84.2%, P=0.91; 67.2% vs. 69.8%, P=0.96, respectively), but freedom from MALE was significantly lower in the EVT group during follow-up (69.1% vs. 51.1%, P=0.002). After adjusting endpoints with covariates, there was also no significant difference in AFS, limb salvage, and overall survival between EVT and BSX. Freedom from MALE, however, was still significantly lower in the EVT group (hazard ratio, 0.66; 95% confidence interval: 0.47-0.92, adjusted P=0.01). Conclusions: Serious adverse events with the exception of MALE after EVT seem to be acceptable compared to that after BSX in patients with CLI due to infrainguinal disease.
Aihara H.,Tsukuba Medical Center Hospital |
Soga Y.,Kokura Memorial Hospital |
Mii S.,Steel Memorial Yawata Hospital |
Okazaki J.,Kokura Memorial Hospital |
And 4 more authors.
Circulation Journal | Year: 2014
Background: Although endovascular therapy (EVT) has advanced, few reports have compared EVT and bypass surgery in claudication patients with femoropopliteal disease. The present study used data from a multicenter registry in Japan to analyze outcomes of EVT and bypass surgery for claudication patients with Trans-Atlantic Inter- Society Consensus (TASC)-II C and D femoropopliteal lesions. Methods and Results: Of 1,156 patients who underwent revascularization, 696 patients were treated for intermittent claudication. A total of 263 patients with femoropopliteal lesion were classified into TASC-II C and D. The primary and secondary patency rates of the EVT and bypass surgery groups were analyzed. The overall complication rate was 14.4% in the bypass surgery group and 3.5% in the EVT group (P<0.01). The 1- and 5-year primary patency rates were 82.1% and 69.4% in the bypass surgery group and 67.8% and 45.2% in the EVT group, respectively. Although the bypass surgery group had a higher primary patency rate than the EVT group (P<0.01, log-rank test), secondary patency rates did not differ significantly between the two groups. Conclusions: Although bypass surgery is clearly feasible for claudication patients with TASC-II C and D femoropopliteal disease, EVT is also a good option because of its lower complication rate and good secondary patency rate in patients in poor condition for bypass.