Faculty Profiles - KUNISADA Toshiyuki

Papers - KUNISADA Toshiyuki

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Factors associated with survival in patients with clear cell sarcoma. International journal

Tomohiro Fujiwara, Toshiyuki Kunisada, Eiji Nakata, Toshiharu Mitsuhashi, Toshifumi Ozaki, Akira Kawai

The bone & joint journal 105-B ( 11 ) 1216 - 1225 2023.11

Language：English Publishing type：Research paper (scientific journal)

AIMS: Clear cell sarcoma (CCS) of soft-tissue is a rare melanocytic subtype of mesenchymal malignancy. The aim of this study was to investigate the clinical and therapeutic factors associated with increased survival, stratified by clinical stage, in order to determine the optimal treatment. METHODS: The study was a retrospective analysis involving 117 patients with histologically confirmed CCS, between July 2016 and November 2017, who were enrolled in the Bone and Soft Tissue Tumour Registry in Japan. RESULTS: The five- and ten-year survival rates were 41% (95% confidence interval (CI) 29 to 52) and 37% (95% CI 25 to 49), respectively. On multivariable analysis, the size of the tumour of > 10 cm (p = 0.006), lymph node metastasis at the time of diagnosis (p < 0.001), distant metastases at the time of diagnosis (p < 0.001), and no surgery for the primary tumour (p = 0.019) were independently associated with a poor survival. For N0M0 CCS (n = 68), the development of distant metastases was an independent prognostic factor for survival (early (< 12 months), hazard ratio (HR) 116.78 (95% CI 11.69 to 1,166.50); p < 0.001; late (> 12 months), HR 14.79 (95% CI 1.66 to 131.63); p = 0.016); neoadjuvant/adjuvant chemotherapy (p = 0.895) and/or radiotherapy (p = 0.216) were not significantly associated with survival. The five-year cumulative incidence of local recurrence was 19% (95% CI 8 to 35) and the size of the tumour was significantly associated with an increased rate of local recurrence (p = 0.012). For N1M0 CCS (n = 18), the risk of mortality was significantly lower in patients who underwent surgery for both the primary tumour and lymph node metastases (HR 0.03 (95% CI 0.00 to 0.56); p = 0.020). For M1 CCS (n = 31), excision of the primary tumour was independently associated with better survival (HR 0.26 (95% CI 0.09 to 0.76); p = 0.013). There was no significant difference in survival between the different types of systemic treatment (p = 0.523). CONCLUSION: Complete excision of the primary tumour and lymph nodes is associated with a better survival in patients with CCS. Systemic treatment appears to provide limited benefits, demonstrating a pressing need for novel systemic agents.

DOI： 10.1302/0301-620X.105B11.BJJ-2022-0743.R3

PubMed

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著明な疼痛を伴う椎間板発生の仙骨脊索腫の一例

藤原智洋, 魚谷弘二, 国定俊之, 中田英二, 小田孔明, 三澤治夫, 尾崎敏文

中国・四国整形外科学会雑誌 35 ( 3 ) 423 - 423 2023.11

【整形外科外来Red Flags 2023】脊椎転移におけるRed Flags

中田英二, 藤原智洋, 国定俊之, 尾崎敏文

Orthopaedics 36 ( 10 ) 69 - 80 2023.10

Language：Japanese Publisher：(株)全日本病院出版会

椎体転移では腫瘍が増大すると腫瘍が直接神経を圧迫したり,椎体圧潰により脊髄が圧迫され,知覚障害や運動麻痺が生じることがある.ほとんどの骨転移患者は,麻痺が発生する前に脊椎転移部に痛みを自覚している.したがって,痛みは麻痺の危険信号であり,脊椎転移部に痛みが出現した場合,早急に治療を開始することが重要である.麻痺を予防するために,最も基本的で重要な対処法は,脊椎転移部に痛みが出現した場合,脊椎SREsの発生も考え,早急に画像検査を行い,痛みの原因と考えられる著しい椎体破壊や脊髄圧迫を認めた場合,早急に治療(RTなど)を行うことである(Red Flag).なお,早急に画像検査が行えない場合,直近のCT等を見直し,椎体破壊の有無を確認すべきである.Red Flagに対して早急に対処し,麻痺が出現する前に治療が開始できれば,麻痺発生数を減らすことができる.(著者抄録)

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骨軟部肉腫の全ゲノム、トランスクリプトーム解析(Whole genome and transcriptome analysis of bone and soft tissue sarcomas)

平井利英, 片山琴絵, 白石友一, 川井章, 吉田朗彦, 小林寛, 大津敬, 国定俊之, 西田佳弘, 吉田新一郎, 近藤格, 柴田龍弘, 井元清哉, 松田浩一, 平田真

日本癌学会総会記事 82回 384 - 384 2023.9

Advances in treatment of alveolar soft part sarcoma: an updated review. International journal

Tomohiro Fujiwara, Toshiyuki Kunisada, Eiji Nakata, Kenji Nishida, Hiroyuki Yanai, Tomoki Nakamura, Kazuhiro Tanaka, Toshifumi Ozaki

Japanese journal of clinical oncology 2023.8

Language：English Publishing type：Research paper (scientific journal)

Alveolar soft part sarcoma is a rare neoplasm of uncertain histogenesis that belongs to a newly defined category of ultra-rare sarcomas. The neoplasm is characterized by a specific chromosomal translocation, der (17) t(X; 17)(p11.2;q25), that results in ASPSCR1-TFE3 gene fusion. The natural history of alveolar soft part sarcoma describes indolent behaviour with slow progression in deep soft tissues of the extremities, trunk and head/neck in adolescents and young adults. A high rate of detection of distant metastasis at presentation has been reported, and the most common metastatic sites in decreasing order of frequency are the lung, bone and brain. Complete surgical resection remains the standard treatment strategy, whereas radiotherapy is indicated for patients with inadequate surgical margins or unresectable tumours. Although alveolar soft part sarcoma is refractory to conventional doxorubicin-based chemotherapy, monotherapy or combination therapy using tyrosine kinase inhibitors and immune checkpoint inhibitors have provided antitumor activity and emerged as new treatment strategies. This article provides an overview of the current understanding of this ultra-rare sarcoma and recent advancements in treatments according to the clinical stage of alveolar soft part sarcoma.

DOI： 10.1093/jjco/hyad102

PubMed

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ヒトiPS細胞由来肢芽間葉系細胞を用いた骨再建法の開発

佐藤浩平, 高尾知佳, 中田英二, 藤澤佑樹, 山田大祐, 上原健敬, 藤原智洋, 依光正則, 国定俊之, 尾崎敏文, 宝田剛志

日本整形外科学会雑誌 97 ( 8 ) S1868 - S1868 2023.8