Kariya Toyota General Hospital

This case highlights that en bloc resection and vascular reconstruction for colorectal cancer involving major vessels-specifically the right common iliac artery and inferior vena cava-may be performed safely even in super-elderly patients, provided that careful preoperative planning and strict surgical field separation are implemented. Our experience suggests that advanced age alone need not automatically preclude curative-intent surgery when functional status is preserved and the patient strongly wishes to undergo treatment.

ABSTRACTAimAlthough perforated colorectal cancer has a poor prognosis, it remains unclear whether this is attributed to the perforation itself or related clinicopathological factors indicating advanced tumor progression. We investigated the true prognostic impact of perforation in colorectal cancer after adjusting for perforation‐related clinicopathological factors.MethodsThis retrospective single‐center cohort study included 2073 patients underwent curative resection for primary colorectal cancer between January 2009 and December 2022 (73 with perforated colorectal cancer and 2000 with nonperforated colorectal cancer). Perforation‐related clinicopathological factors were identified by multivariate logistic regression and used for 1:2 propensity score matching as covariates. Recurrence‐free survival and overall survival were analyzed using Kaplan–Meier estimates and Cox proportional hazards models.ResultsIndependent perforation‐related clinicopathological factors were age ≥ 75 years, left‐sided tumor, and pathological T Stage 4 (pT4). The perforated colorectal cancer group had a lower rate of minimally invasive surgery (62.5% vs. 90.6%), fewer harvested lymph nodes (medians: 13 vs. 16.5), and more frequent major postoperative complications (18.8% vs. 7.3%) compared to the nonperforated colorectal cancer group. Multivariate Cox analysis revealed that pT4 and perforation independently predicted worse recurrence‐free survival and overall survival. The hazard ratios were 2.71 and 2.54 for pT4 (95% confidence intervals: 1.45–5.04 and 1.08–5.9), and 2.67 and 3.30 for perforation (95% confidence intervals: 1.44–4.96 and 1.37–7.96), respectively.ConclusionPerforation independently predicted poor prognosis in colorectal cancer, highlighting its distinct oncologic relevance beyond standard pathological staging. Prospective studies should establish individualized strategies to improve outcomes in perforated colorectal cancer.

We report a rare paediatric case of post-dural puncture headache (PDPH) with delayed onset and atypical interscapular pain. An adolescent boy was admitted with headache and vomiting following Mycoplasma pneumoniae infection. On hospital day 2, lumbar puncture (LP) revealed clear cerebrospinal fluid (CSF) with mild pleocytosis, confirming the diagnosis of M. pneumoniae meningitis. His symptoms improved, and he was discharged on hospital day 6. On LP day 6, he developed recurrent headache with interscapular pain aggravated by movement. Whole-spine MRI on LP day 10 demonstrated a dorsal epidural CSF collection extending from Th1 to L5 with the floating dural sac sign, consistent with PDPH. He was managed conservatively and recovered fully. Follow-up MRI confirmed marked reduction of the CSF collection with improvement of spinal cord displacement. Extensive CSF spread is uncommon in children, and early whole-spine MRI is valuable in atypical cases of PDPH.

We investigated changes in eating behavior associated with the administration of tirzepatide and evaluated any changes in diet-related QOL due to tirzepatide. The study included 60 outpatients with type 2 diabetes mellitus who had been on tirzepatide for 3months. The changes in body weight and HbA1c levels of all participants were observed for 3months following the initiation of tirzepatide treatment. Simultaneously, we conducted a questionnaire survey that included questions on their eating behavior (Eating Behavior Questionnaire) and diet-related quality-of-Life (DDRQOL). HbA1c levels significantly reduced after the first month of administration from 7.40 ± 1.58% at the start to 6.78 ± 0.99% after 3months (p < 0.001). Body weight also significantly decreased from 80.7 ± 13.2kg at the start to 78.3 ± 12.9kg after 3months (p < 0.001). The total Eating Behavior Questionnaire score significantly reduced from 52.9 ± 10.9 points to 47.7 ± 9.9 points after 3months (p < 0.001). There was a strong positive correlation only between the variations of the total score of the Eating Behavior Questionnaire and weight variations (r = 0.363, p = 0.005). Regarding the scores by subscales of DDRQOL, "Satisfaction with diet" changed from 75.3 ± 14.5 points at the start to 73.9 ± 14.8 points after 3months, showing no significant changes (p = 0.335). "Burden of diet therapy" significantly increased from 50.8 ± 14.9 points to 56.1 ± 15.9 points (p = 0.002), as did "Perceived merits of diet therapy" from 57.9 ± 13.9 points to 61.8 ± 11.2 points (p = 0.035). Administration of tirzepatide improved eating behavior, leading to increased diet-related QOL and decreased HbA1c levels and body weight.

Introduction: Liver injury is a treatment-related adverse event (liver-TRAE), one of the most common complications of atezolizumab plus bevacizumab (Atez/Bev) therapy, when treating unresectable hepatocellular carcinoma (uHCC). Fever following immune checkpoint inhibitor (ICI) therapy may predict ICI-induced liver injury in various malignancy types. However, the association between fever and liver-TRAEs in patients with uHCC treated with Atez/Bev has not been investigated. We prospectively evaluated the relationship between the onset of liver-TRAEs and preceding fever and sought to identify circulating biomarkers that predict liver injury in patients with Atez/Bev-treated uHCC. Methods: The primary outcome of this prospective, multicenter study was the association between liver-TRAEs (grade ≥2) and the presence of ICI-induced fever before the onset of liver injury. We used a multiplex bead-based immunoassay to evaluate 40 circulating proteins in the serum before and at 1, 3, and 6 weeks after initial Atez/Bev treatment. Results: Among 99 patients receiving Atez/Bev, grade ≥2 liver-TRAEs occurred in 10 (10.1%) during the follow-up period (median, 14.7 months). The incidences of liver-TRAEs associated with fever before liver injury were 27.8% (n = 5/18) and 6.2% (n = 5/81) in the fever and non-fever groups, respectively. Multivariable analysis showed that the presence of fever was a significant risk factor for liver-TRAEs (odds ratio 7.57; 95% confidence interval, 1.83–33.89; p = 0.006). Furthermore, the prognosis was worse in the liver-TRAE (grade ≥2) group (p = 0.065 for progression-free survival and p = 0.074 for overall survival). Among patients with preceding fever, the liver-TRAE group had significantly lower CXCL-5 levels before treatment, higher IL-6 levels at 1 and 3 weeks, and lower CXCL-5, IFN-γ, and IL-10 levels at 6 weeks (p < 0.05). Conclusion: Fever during Atez/Bev treatment may predict liver-TRAEs, which leads to poor prognosis in patients with uHCC. Altered inflammatory cytokine and chemokine levels may help predict liver-TRAEs in patients with fever after Atez/Bev therapy.

Background:EGFR L858R mutation is associated with poorer efficacy of EGFR-tyrosine kinase inhibitors (TKIs) than EGFR Ex19del in patients with non-small cell lung cancer (NSCLC). However, ramucirumab (RAM) + erlotinib (ERL) therapy exhibited comparable efficacy between patients with L858R mutation and Ex19del mutation (median progression-free survival (PFS): 19.6 vs 19.4 months) in the RELAY study, with favorable PFS for both gene mutations at 19.4 months in the Japanese subset. Meanwhile, the FLAURA study revealed shorter PFS with osimertinib (OSI) for L858R mutation than Ex19del mutation, with poorer PFS in the Japanese subset than in the overall population. The treatment discontinuation rates of RAM + ERL and OSI in Japanese patients were 18% and 29%, respectively. Consequently, RAM + ERL may exhibit superior efficacy and safety in Japanese patients with the L858R mutation.Objectives:To evaluate the therapeutic efficacy and safety of RAM + ERL as a first-line treatment for advanced or recurrent NSCLC harboring the L858R mutation in Japanese patients.Design:A multicenter, noninterventional, retrospective cohort study.Methods and analysis:This study will involve patients with advanced or recurrent NSCLC (ECOG PS score 0–2) with L858R mutation who received RAM + ERL between November 1, 2020 and August 31, 2023, with the planned sample size of 200 patients. The primary endpoint is time to treatment failure, and the secondary endpoints are overall survival, PFS, PFS2, time to discontinuation of any EGFR-TKI, time to failure of strategy, objective response rate, disease control rate, and safety. Exploratory endpoints are effects of ERL and RAM on PD-L1 expression and neutrophil-to-lymphocyte ratio.Discussion:To the best of our knowledge, this is the first retrospective study focusing on L858R mutations associated with the RELAY regimen, providing the corresponding real-world data.Trial registration:UMIN Clinical Trials Registry identifier: UMIN000052047.

99mTechnetium-pyrophosphate ([99mTc]Tc-PYP) scintigraphy is the gold standard for diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM). Conventional metrics, such as heart-to-contralateral-chest (H/CL) ratio and visual Perugini score, can be influenced by physiological blood pool uptake, leading to false positives and additional patient burdens. This study aimed to develop and validate a simple quantitative metric widely applicable for ATTR-CM diagnosis. This multicenter retrospective study enrolled 253 patients who underwent [99mTc]Tc-PYP SPECT/CT between April 2021 and September 2024. SPECT/CTs were acquired 3h post-injection of 740 MBq [99mTc]Tc-PYP. A lateral wall-to-aorta (LW/Ao) ratio was obtained by dividing the average radiotracer count in the lateral wall of the left ventricle by the average count in the ascending aorta. The diagnosis of ATTR-CM diagnosis was determined by endomyocardial biopsy. As statistical analyses, area under receiver operating characteristic (AUC) was used to compare diagnostic accuracy, and intraclass correlation coefficient (ICC) was used to assess inter-rater agreement. Among 52 patients (31 men; mean age 77) whose biopsy results were available, 11 were diagnosed with ATTR-CM. LW/Ao ratio showed a sensitivity of 100% (11/11), specificity of 97.6% (40/41), and positive likelihood ratio of 41.0. LW/Ao ratio showed higher AUC (0.99; 95% CI: 0.99-1.00) compared to H/CL ratio (AUC = 0.90, p = 0.04) and visual score (AUC = 0.87, p < 0.01). The ICC of LW/Ao ratio was excellent (0.91 ≥ 0.9). The quantitative SPECT/CT metric demonstrated superior diagnostic accuracy for ATTR-CM compared to conventional methods.

Type 1 autoimmune pancreatitis (AIP) frequently involves biliary lesions and poses diagnostic and therapeutic challenges. We aimed to evaluate the clinical features and long-term prognosis of type 1 AIP with a focus on the locations of bile duct lesions. In this retrospective study, 159 patients with type 1 AIP were included. Patients were classified on the basis of the location of bile duct strictures, and clinical outcomes, including relapse rates and steroid dependency, were analyzed. Eighty-nine (56%) patients had bile duct involvement. Forty-nine patients (30.8%) experienced relapse, with a significantly higher cumulative relapse rate in cases of stricture or wall thickening upstream of the intrapancreatic bile duct (3 years: 24% vs. 37.1%, p < .001). These patients also had a significantly higher rate of two or more relapses than did the patients without stricture or wall thickening (5.1% vs. 19.5%, p = .01). Two patients with stricture and dilation up to the intrahepatic bile ducts became steroid-dependent and were treated with azathioprine. Patients with type 1 AIP with biliary lesions involving upstream strictures or wall thickening, especially those with stricture and dilation extending into the intrahepatic bile ducts, are at high risk of relapse and may become steroid dependent.