Japanese Stage Research Articles

Comparison of different risk stratifications for gastric cancer and establishing a simplified risk-scoring model based on the Kyoto classification.

The study aims to assess the value of different risk stratifications in diagnosing early gastric cancer (GC) and explore risk factors based on Kyoto gastritis classification. This study was a single-centered cross-sectional study; all epidemiological data and endoscopic findings were obtained prospectively. To evaluate the proportion of GC in each risk stratification and to compare the diagnostic performance of different methods using the receiver operating characteristic curve, univariable and multivariable analyses were used to explore the correlation between endoscopic findings and GC. A total of 240 subjects were enrolled, and the diagnostic efficacy of the Kyoto Classification Score was similar to Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stage, and the accuracy was higher than that of the Japanese scoring system and OLGA stage. Moderate atrophy (odds ratio [OR]=3.52, 95% confidence interval [CI]: 1.52-8.16), severe atrophy (OR=4.96, 95% CI: 1.75-14.04), map-like redness (OR=9.89, 95% CI: 1.16-84.15), and xanthelasma (OR=3.57, 95% CI: 1.15-11.15) were independent risk factors for GC. The simplified Kyoto classification (area under the receiver operating characteristic [AUROC]=0.76, P=0.58) based on multivariable analysis demonstrated favorable diagnostic value compared with traditional Kyoto classification score (AUROC=0.74). This study confirms the value of the Kyoto classification score and the OLGIM stage in the risk stratification of GC. Simplified Kyoto classification is also promising in risk assessment of GC but still requires validation in the population.

Genomic landscape and its prognostic significance in stage III colorectal cancer: JCOG1506A1, an ancillary of JCOG0910.

Large-scale genomic sequencing of colorectal cancers has been reported mainly for Western populations. Differences by stage and ethnicity in the genomic landscape and their prognostic impact remain poorly understood. We investigated 534 Japanese stage III colorectal cancer samples from the Phase III trial, JCOG0910. Targeted-capture sequencing of 171 potentially colorectal cancer-associated genes was performed, and somatic single-nucleotide variants and insertion-deletions were determined. Hypermutated tumors were defined as tumors with MSIsensor score >7 and ultra-mutated tumors with POLE mutations. Genes with alterations associated with relapse-free survival were analyzed using multivariable Cox regression models. In all patients (184 right-sided, 350 left-sided), mutation frequencies were TP53, 75.3%; APC, 75.1%; KRAS, 43.6%; PIK3CA, 19.7%; FBXW7, 18.5%; SOX9, 11.8%; COL6A3, 8.2%; NOTCH3, 4.5%; NRAS, 4.1%; and RNF43, 3.7%. Thirty-one tumors were hypermutated (5.8%; 14.1% right-sided, 1.4% left-sided). Modest associations were observed: poorer relapse-free survival was seen with mutant KRAS (hazard ratio 1.66; p = 0.011) and mutant RNF43 (2.17; p = 0.055), whereas better relapse-free survival was seen with mutant COL6A3 (0.35; p = 0.040) and mutant NOTCH3 (0.18; p = 0.093). Relapse-free survival tended to be better for hypermutated tumors (0.53; p = 0.229). In conclusion, the overall spectrum of mutations in our Japanese stage III colorectal cancer cohort was similar to that in Western populations, but the frequencies of mutation for TP53, SOX9, and FBXW7 were higher, and the proportion of hypermutated tumors was lower. Multiple gene mutations appeared to impact relapse-free survival, suggesting that tumor genomic profiling can support precision medicine for colorectal cancer.

The clinical impacts of postoperative complications after colon cancer surgery for the clinical course of adjuvant treatment and survival

AimWe investigated whether or not postoperative complications (POCs) themselves have a negative survival impact or indirectly worsen the survival due to insufficient adjuvant chemotherapy in a pooled analysis of two large phase III studies performed in JapanPatients and methodsThe study examined the patients who enrolled in 1304, phase III study comparing the efficacy of 6 and 12 months of capecitabine as adjuvant chemotherapy for stage III colon cancer patients and in 882, a phase III study to confirm the tolerability of oxaliplatin, fluorouracil, and l-leucovorin in Japanese stage II/III colon cancer patients. In our study, POCs were defined as the following major surgical complications: anastomotic leakage, pneumonia, bowel obstruction/ileus, surgical site infection, postoperative bleeding, urinary tract infection, and fistula. Patients were classified as those with POCs (C group) and those without POCs (NC group).ResultsA total of 2095 patients were examined in the present study. POCs were observed in 169 patients (8.1%). The overall survival (OS) rates at 5 years after surgery were 75.3% in the C group and 86.5% in the NC group (p = 0.0017). The hazard ratio of POCs for the OS in multivariate analysis was 1.70 (95% confidence interval, 1.19 to 2.45; p = 0.0040). The time to adjuvant treatment failure (TTF) of adjuvant chemotherapy was similar between the groups, being 68.6% in the C group and 67.1% in the NC group for the 6-month continuation rate of adjuvant chemotherapy. The dose reduction rate of adjuvant chemotherapy and adjuvant treatment suspension rate were also similar between the groups (C vs. NC groups: 45.0% vs. 48.7%, p = 0.3520; and 52.7% vs. 55.0%, p = 0.5522, respectively).ConclusionPOCs were associated with a poor prognosis but did not affect the intensity of adjuvant chemotherapy. These results suggested that POCs themselves negatively influence the survival.

Odinochestvo i «samost'» vlyublennyh zhenshchin: «Sumerki pozdnego leta» Ekuni Kaori

In the late 1980s, Japanese women writers stepped onto the Japanese literary stage. They incorporated women's themes into their literary creations, closely linking women's subjective consciousness with Japanese social culture while expressing feminist thoughts. Among them, Ekuni Kaori is famous for writing love stories thematically focused on the “self of women" and “love" (relationships). Therefore, this article explores how Ekuni's “Twilight of Late Summer" constructs feminine writing to show that loneliness is the key for a heroine to discover her true self in a desperate relationship.

Application value of neutrophil lymphocyte ratio combined with age in the diagnosis of dual-phenotype hepatocellular carcinoma

Objective: This study retrospectively analyzed the clinical medical records of patients with dual phenotypic liver cancer (DPHCC) and those (non-DPHCC) in the same period to seek quick and effective biomarkers for differential diagnosis. Methods: A retrospective study was conducted on 164 patients who underwent radical hepatocellular carcinoma resection at Affiliated Hospital of Nantong University from May 2017 to May 2020, including 29 patients with DPHCC, accounting for 17.7% (age: 53.9±10.0). There were 135 non-DPHCC patients, accounting for 82.3% (age, 62.6±9.1). The clinical records of the above patients were collected,including the basic information of the patients, clinical symptoms and signs, history of infection, laboratory test indexes one day before surgery, postoperative pathological report and other relevant data, The follow-up time was 18 months and the data were complete. By analyzing the clinical data of DPHCC patients and non-DPHCC patients in the same period, to find quick and effective differential diagnostic indicators, and to explore the indicators indicating poor prognosis of DPHCC patients. Results: One-way ANOVA showed significant differences in age, AFP[143(4.8-984.8) vs 9.9(2.8-71.3) μg/L], NLR (3.650±1.924 vs 2.220±1.486), neutrophil count, lymphocyte count, vascular infiltration rate, TNM stage, Chinese Hepatocellular carcinoma Staging (CNLC), Child grade, and Japanese General Staging Score (JIS) (P<0.05). Multivariate logistic regression analysis identified age(OR score:0.967,95%CI:0.860-0.957) and NLR(OR score:1.564,95%CI:1.205-2.029) as independent risk factors for DPHCC differential diagnosis. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficiency of NLR, and the best cut-off value was 2.586. The combination of age at onset improved the efficiency of differential diagnosis. When reaching the maximum diagnostic efficiency, the area under curve(AUC) was 0.836, the sensitivity was 89.66%, and the specificity was 65.93%. Conclusion: NLR combined with the age of disease has certain feasibility in predicting DPHCC and may be an effective index to distinguish DPHCC from non-DPHCC patients.

Analysis of Factors Influencing Postoperative Femoral Head Collapse in Patients With Ficat I, II, and III Stages of Aseptic Necrosis of the Femoral Head.

To investigate the factors influencing postoperative femoral head collapse (FHC) in patients with Ficat I, II, and III stages of aseptic necrosis of the femoral head (ANFH). Retrospective analysis of 178 patients with ANFH admitted to our hospital from October 2018 to October 2021 was studied, and patients were categorized into the FHC group and no FHC group according to whether FHC occurred after surgery. The influencing factors causing postoperative FHC were analyzed by univariate and multifactor logistic regression. In the collapsed group, there were statistically significant differences in etiology, extent of necrosis, mechanism of injury, preoperative waiting time, Japanese Femoral Necrosis Research Society staging, distance from the tip of the tantalum rod to the center of necrosis, and Harris score after treatment ( P < 0.05). The etiology, extent of necrosis, mechanism of injury, preoperative waiting time, Japanese Femoral Osteonecrosis Research Society classification, distance between the tantalum rod tip and the center of necrosis, and Harris score after treatment were set as independent variables, and postoperative FHC in patients with Ficat I, II, and III stages of ANFH was used as the dependent variable in the univariate logistic regression analysis. Hormonal osteonecrosis of the femur, extent of necrosis, type C1 and type C2 in the Japanese Society for the Study of Femoral Osteonecrosis staging, and distance of the tip of the tantalum rod from the center of necrosis are risk factors for postoperative FHC in patients with Ficat I, II, and III stages of ANFH.

Survival analysis among pediatric patients receiving kidney replacement therapy: a Japanese nationwide cohort study.

Limited data are available on the survival and causes of death in pediatric patients with chronic kidney disease (CKD) stage 5 receiving kidney replacement therapy (KRT) in Asia. Data were obtained from the Japanese nationwide cross-sectional CKD stage 5 survey on pediatric patients (<20 years of age) who started KRT from 2006 to 2013. The cohort was divided into three groups according to age at the start of KRT: <1, 1-5, and 6-19 years. Among the 701 children who were included, 59.3% were boys. Peritoneal dialysis was the most common initial modality of KRT (60.3%). Median age at KRT initiation was 10.2 years. Infants (<1 year old) accounted for 16.0% of the total cohort. Overall survival at 1 and 5 years was 97.2% and 92.5%, respectively. Infants had significantly lower survival rates than the other groups (hazard ratio, 5.35; 95% CI, 2.60-11.03; P < 0.001). In contrast, after the age of 1 year, the survival rate improved and did not differ from that of other age groups. The most common causes of death were infection (35.9%) and sudden death (15.4%). The overall survival rate of pediatric patients with CKD stage 5 in Japan is like that in other high-income countries. Age at initiation of KRT is an important factor affecting survival since the poorest survival rate was observed in infants. Further improvement in infant dialysis therapy is still needed to improve survival of the youngest children. A higher resolution version of the Graphical abstract is available as Supplementary information.

Efficacy and safety of ultra-high dose methylcobalamin in early stage amyotrophic lateral sclerosis: Results of a randomized, double-blind, phase 3 trial (JETALS)

Clinical and non-clinical studies have shown that intramuscular ultra-high dose methylcobalamin is potentially effective against amyotrophic lateral sclerosis (ALS). Post hoc analyses in a previous phase 2/3 clinical trial showed that methylcobalamin prolonged survival time and arrested functional decline compared to placebo in patients registered within 12 months of ALS onset. The objective of the next trial: The Japanese Early Stage Trial of High Dose Methylcobalamin for Amyotrophic Lateral Sclerosis (JETALS), was to reconfirm the efficacy and safety of ultra-high dose methylcobalamin for ALS patients in their early stages. (NCT03548311).

Phase 3 trial of ultra-high dose methylcobalamin in early-stage amyotrophic lateral sclerosis

In the post-hoc analyses of our previous study conducted to verify efficacy and safety of ultra-high dose methylcobalamin against patients diagnosed by the revised El Escorial criteria (rEEC), methylcobalamin may prolong survival and retard symptomatic progression without major side effects if started early (≤12 months' duration). The objective of next trial: The Japanese Early Stage Trial of High Dose Methylcobalamin for Amyotrophic Lateral Sclerosis (JETALS) is to reconfirm the efficacy and safety of ultra-high dose methylcobalamin for ALS patients in their early stages.

Impact of the changes in the completion lymph node dissection criteria and approval of adjuvant therapies on the real-world outcomes of Japanese stage III melanoma patients.

Completion lymph node dissection (CLND) has long been the standard treatment for stage III melanomas identified as metastasis on the sentinel node (SN-positive). Two major changes occurred in 2017 and 2018, the change in the CLND criteria for SN-positive patients and the approval of several adjuvant therapies could revolutionize such management approach. However, their effects have not been fully investigated on the real-world outcomes of stage III melanoma patients. Therefore, we investigated the impact of these changes on the prognosis of Japanese stage III melanoma patients. Totally, 119 stage III, SN-positive melanoma patients were included. They were categorized into those diagnosed as SN-positive between January 2015 and June 2017 (pre-June 2017 group) and between July 2017 and December 2019 (post-July 2017 group). Recurrence-free survival (RFS), overall survival, and prognostic factors were analyzed. The frequency of patients who received CLND was significantly higher in the pre-June 2017 group (p = 0.001), and those who received adjuvant therapy were significantly higher in the post-July 2017 group (p < 0.001). The 2-year RFS was 50.1% and 68.5% in the pre-June and post-July 2017 groups, respectively (p = 0.049). Cox proportional hazards model analysis for RFS showed that adjuvant therapies reduce the risk of recurrence (hazard ratio 0.37; 95% confidence interval 0.14-0.99; p = 0.047). Changes in the CLND criteria in SN-positive patients and the approval of adjuvant therapies for stage III melanomas have significantly impacted Japanese melanoma medicine. Adjuvant therapy tended to prolong patient's RFS while omitting immediate CLND had no significant negative influence on it.

Efficacy and safety of nintedanib in Japanese patients with early-stage idiopathic pulmonary fibrosis: a study protocol for an observational study

IntroductionIdiopathic pulmonary fibrosis (IPF) is a fibrotic disease of unknown aetiology with a poor prognosis. Several clinical trials of nintedanib in patients with IPF have reported its inhibitory effect on...

Paragons of Loyalty on the Japanese Stage

Paragons of Loyalty on the Japanese Stage

Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification.

The 9th Japanese Classification of Colorectal Cancer (9th JSCCR) has two main differences from the TNM classification (8th AJCC): first, main or lateral lymph node metastasis is classified as jN3; second, tumor nodules (ND) are treated as lymph node metastasis. In this study, we verified the 9th JSCCR for rectal cancer, focusing on the differences with the 8th AJCC. This retrospective analysis involved 212 patients with stage I-III rectal cancer. ND was evaluated using whole-mount sections. We evaluated the relapse-free survival of each staging system, and compared the prognostic significance of the different staging systems using the Akaike information criterion (AIC) and Harrell's concordance index (c-index). Main or lateral lymph node metastasis was detected in nine of 212 (4%) patients. ND was detected in 79 of 212 (37%) patients. The best risk stratification power was observed in the 9th JSCCR (AIC, 759; c-index, 0.708) compared with the 7th JSCCR (AIC, 771; c-index, 0.681), 8th JSCCR (AIC, 768; c-index, 0.696), and the 8th AJCC (AIC, 766; c-index, 0.691). The 9th JSCCR, which includes the concepts of jN3 and ND, is useful for the risk stratification of rectal cancer, and the contributes to precise decision-making for follow-up management and adjuvant therapy.

Liver biopsy in primary biliary cholangitis: is sinusoidal fibrosis the missing key?

AimsThe role of liver biopsy in primary biliary cholangitis (PBC) is controversial, as is the optimal method of histological assessment. We compared the Ludwig and Ishak systems and three components...

한·중·일 무대복식 문화의 경계와 삼투에 관한 연구 -가면극·경극·가부키에 체현된 문화의지와 미의식을 중심으로-

한·중·일 무대복식 문화의 경계와 삼투에 관한 연구 -가면극·경극·가부키에 체현된 문화의지와 미의식을 중심으로-

A New N Staging System for Colorectal Cancer in the Era of Extended Lymphadenectomy.

Complete mesocolic excision is becoming popular in colon cancer surgery in Western countries, and in the tumor-node-metastasis (TNM) classification of rectal cancer, a part of the lateral pelvic lymph nodes is classified as regional. However, the appropriateness of TNM staging according to the assessment of nodal status exclusively by extended lymphadenectomy remains unclear. Using a nationwide multicenter database in Japan, we retrospectively analyzed 6866 patients with stage III colorectal cancer (CRC) treated with extended (D3) dissection. First, the best cutoff values for the number of metastatic nodes were explored. Second, the utility of the metastatic status of the main lymph nodes (i.e., at the origin of the feeding artery) and the lateral pelvic lymph nodes ("jN3" category in the Japanese staging system) as N staging criteria was evaluated. The modified N staging system that had the best risk stratification power was determined according to the Akaike information criterion (AIC). Excellent performance was noted when the number of metastatic nodes was categorized by cutoff values of "3/4" and "6/7." Categorization of nodal metastasis was proven the most clinically efficacious when classified as modified-N1 (N1 and jN3-negative), modified-N2a (N2a and jN3-negative), and modified-N2b (N2b and/or jN3-positive; AIC, 22,810.8), rather than the classification based on the TNM (AIC, 22,849.2) or Japanese staging system (AIC, 22,811.1). We structured a modified N staging system according to the number and extent of lymph node metastases. The modified system may be used in stage III cases for precise risk stratification.

Comparison of the 11th Japanese classification and the AJCC 7th and 8th staging systems in esophageal squamous cell carcinoma patients.

Although the American Joint Committee on Cancer (AJCC) staging system has been used worldwide for esophageal squamous cell carcinoma (ESCC), another staging system has been proposed by Japanese surgeons. The two systems have different lymph node maps, N staging, and stage grouping. This retrospective study compared the predictive ability of these two staging systems for survival. We retrospectively reviewed records for 143 patients who underwent esophagectomy and mediastinal lymphadenectomy for ESCC from January 2006 to July 2015. Patients were staged by 7th, 8th AJCC stage and 11th Japanese classification. The concordance indexes (C-indexes) of these staging systems were compared. Mean age was 63.14±8.10 years with 131 (91.6%) men. Median follow-up was 47.73 (6.27-134.40) months. All patients received R0 resection. Recurrences developed in 30 (20.9%) patients. Both AJCC N staging and Japanese N staging well predicted disease-free survival (DFS) (P<0.001). Stage groupings of AJCC 7th and 8th and Japanese 11th classification also predicted DFS well (P<0.001). The c-index was 0.755 (95% CI, 0.650-0.860) for AJCC N staging and 0.734 (0.634-0.835) for Japanese N staging (P=0.11). The c-index was 0.813 (0.732-0.896) for AJCC 7th stage grouping, 0.805 (0.726-0.885) for AJCC 8th, and 0.837 (0.766-0.908) for Japanese stage grouping. The C-index for the Japanese stage grouping was slightly higher than for AJCC, but differences were not significant. Both N staging and stage grouping for the 11th Japanese classification and 7th and 8th AJCC staging for ESCC showed similar predictive power for DFS. Both systems could be applied in clinical situations.

A Body of Accents

Abstract Dance practice is often hidden inside dance studios, where it is not available for dialogue or interdisciplinary critique. In this paper, I will look closer at one of the accents that my body has held since the year 2000. To Swedish dance academies, it is perhaps the most foreign accent I have in my dance practice. It has not been implemented as ‘professional dance’ in Western dance studios. This foreign accent is called Nihon Buyō, Japanese dance, also known as Kabuki dance. Nihon Buyō, Nō or Kabuki are local performing arts practices for professional performers in Japan. A few foreigners are familiar with these practices thanks to cultural exchange programmes, such as the yearly Traditional Theatre Training at Kyoto Art Centre. There is no religious spell cast over the technique or a contract written that it must be kept secret or that it must not leave the Japanese studio or the Japanese stage. I will compare how dance is being transmitted in the studio in Kyoto with my own vocational dance education of many years ago. Are there similarities to how the female dancer’s body is constructed? Might there be unmarked cultural roots and invisible originators of the movements we are doing today in contemporary dance?

Interactive Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers or Their Combination on Survival of Hemodialysis Patients

Background: Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. Methods: We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8,229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. Results: Among 3,762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1,226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50–0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57–1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22–5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. Conclusion: Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations.

Recepcii rossijskogo iskusstva v kul'ture YAponii

Japan is one of the most developed countries in the world. Cooperation with Japan is an important factor in the development of economic, political and cultural contacts of modern Russia. At the present time, we have all the conditions for cooperation and development of relations between these two countries. One of the main article’s tasks is to demonstrate how some historical aspects influenced the origin of Russian art adoption on the example of Russian literature, which serves as an impulse for further study of artistic culture spheres. New aspects of Russian culture’s interest in Japan result in study and translations of literature works such as the production of Chekhov’s plays on the Japanese theater stage, the adaptation of the works of F. M. Dostoevsky by a film director A. Kurosawa. The appeal to historical sources and literary works, visits to Japanese scholar’s seminars and the study of films led to the attempts to adopt Russian art to the modern, up-to-date requirements of Japanese culture. One of the most striking examples proving this trend is the creation of the instrument matryomin by the Japanese musician Masami Takeuchi. This instrument consists of the theremin, which is embedded in the case of the Russian doll Matryoshka. The topic of adoption study, its relevance, is repeatedly confirmed by such facts as the conferencing (on the territory of Russia and Japan), which Japanese Rusists, students who come to Russia for exchange, studying Russian take part in, indicate the attitude and perception of Russian art. These aspects allow us to assume the further development of the adoption of Russian art in Japan in much more new spheres.