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Faculty of Medicine School of Medicine Department of Developmental and Urological-Reproductive Medicine, Urology |
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Associate Professor |
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Related SDGs |
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SAWADA Atsuro
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Papers 【 display / non-display 】
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Shimatani K., Kubota M., Yamamoto S., Mizuno K., Sumiyoshi T., Saito R., Ueda M., Iguchi R., Takahashi T., Yokozeki H., Iwamura H., Kohei N., Kurahashi R., Sekine Y., Sawada A., Negoro H., Akamatsu S., Kobayashi T., Goto T.
World Journal of Urology 44 ( 1 ) 2026.12
Publishing type：Research paper (scientific journal) Publisher：World Journal of Urology
Purpose: Among Grade Group (GG) 5 prostate cancers (PCa), based on the Gleason grading system, those diagnosed preoperatively with Gleason score (GS) 5 + 4 have been reported to have poorer oncological prognoses compared to those with GS 4 + 5. However, the confounding effects of factors such as serum PSA level and clinical T stage remain unresolved. This study aimed to evaluate the impact of GS 5 + 4 versus 4 + 5 on postoperative prognosis, accounting for potential confounders. Methods: This nationwide, multi-institutional retrospective cohort study included 827 patients who underwent robot-assisted radical prostatectomy (RARP) at 25 tertiary centers between 2011 and 2022. Patients were classified by preoperative biopsy as GS 4 + 5 (n = 671) or GS 5 + 4 (n = 156). Biochemical recurrence (BCR)-free survival was compared using inverse probability of treatment weighting (IPTW) and Cox regression, adjusting for age, BMI, PSA, clinical T stage, ASA physical status, and the use of extended lymph node dissection, nerve-sparing, and neoadjuvant hormone therapy. Results: The median follow-up was 33.7 months. Adjusted 3- and 5-year BCR-free survival rates were 66.0% and 57.8% for GS 4 + 5, versus 54.8% and 44.6% for GS 5 + 4. GS 5 + 4 remained significantly associated with worse BCR-free survival compared to GS 4 + 5 (HR 1.41, 95% CI 1.04–1.89, p = 0.039). Conclusion: Among GG 5 PCa, GS 5 + 4 was associated with significantly poorer BCR-free survival compared to GS 4 + 5, even after adjustment for key confounders. These findings support considering further risk refinement within GG 5.
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Masui K., Hayata N., Yamasaki T., Yamaguchi T., Kanno T., Ito N., Yoshimura K., Masui S., Segawa T., Kanamaru S., Okumura K., Onishi H., Shichiri Y., Ishitoya S., Sumiyoshi T., Kita Y., Goto T., Kobayashi T., Sawada A.
Japanese Journal of Clinical Oncology 56 ( 3 ) 337 - 344 2026.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Clinical Oncology
Objective To identify pretreatment factors associated with developing primary resistance to nivolumab plus ipilimumab therapy in patients with advanced renal cell carcinoma (RCC). Methods We retrospectively reviewed the clinical characteristics, laboratory data, and tumor-related factors in patients with advanced RCC who initiated nivolumab plus ipilimumab as first-line therapy between January 2018 and July 2021. Primary resistance was defined as radiographic or clinical progression within 3 months of treatment initiation. Cases with suspected pseudoprogression were excluded. Results Eighty-nine patients met the inclusion criteria; 23 exhibited primary resistance. Univariate analysis identified the following significant predictive factors: body mass index (P =.006), lymph node metastasis (P =.021), sarcomatoid differentiation (P =.035), solitary metastatic organ (P =.051), liver metastasis (P =.056), and serum lactate dehydrogenase (LDH) (P =.094). Receiver operating characteristic curve analysis determined an LDH cutoff value of 174 U/L, which was significantly associated with primary resistance (P =.029). Considering the number of primary resistance cases, multivariable analysis incorporated three candidate variables (lymph node metastasis, sarcomatoid differentiation, and LDH ≥ 174 U/L) and identified sarcomatoid differentiation (odds ratio, 4.264; 95% confidence interval (CI), 1.299–14.825; P =.017) and LDH ≥ 174 U/L (odds ratio, 3.634; 95% CI, 1.143–13.770; P =.028) as independent predictors of primary resistance. Conclusions Sarcomatoid differentiation on pretreatment biopsy or elevated serum LDH before treatment initiation may predict primary resistance to nivolumab plus ipilimumab therapy in patients with advanced RCC. Alternative regimens should be considered in such cases, particularly for patients who are likely to experience rapid disease progression or for whom the occurrence of P-res is not clinically acceptable.
DOI： 10.1093/jjco/hyaf197
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Yamada S., Sato M., Osawa T., Harabayashi T., Miki J., Kobayashi T., Hashine K., Kawashima A., Matsumoto T., Mochizuki T., Taoka R., Urabe F., Tatarano S., Sawada A., Kojima T., Takahashi A., Yokomizo A., Suekane S., Hashimoto K., Hashimoto Y., Yatsuda J., Morita K., Kobayashi K., Satake Y., Sazawa A., Matsui Y., Ito Y.M., Shimizu S., Fukuhara S., Nishiyama H., Kitamura H., Shinohara N.
Cancer Science 117 ( 3 ) 739 - 748 2026.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Cancer Science
This multicenter longitudinal study was conducted across 24 institutions in Japan to examine the impact of urinary diversion on health-related quality of life (HRQOL) among bladder cancer patients who underwent radical cystectomy (RC). We evaluated bladder cancer-specific HRQOL and general HRQOL via the bladder cancer index (BCI) and the QOL General (QGEN-8), respectively, before the operation and at 3, 6, and 12 months postoperatively. The scores were compared across urinary diversion groups as well as across different time points within each urinary diversion group with linear mixed-effects models. Data from 227 patients were analyzed (151 with ileal conduits, 45 with ureterostomy, and 31 with neobladders). Neobladder patients were more likely to experience longitudinal impacts of their urinary diversion on urinary function than ileal conduit or ureterostomy patients were. Compared with that at baseline, the bowel function of neobladder patients remained impaired 12 months after surgery. All urinary diversion groups had worse sexual function scores at 3 and 6 months than at baseline, and the ileal conduit and neobladder groups had significantly worse sexual function scores at 12 months than at baseline. On the other hand, there was no significant difference in bother scores in the urinary, bowel, or sexual domain. The generic HRQOL was maintained from the preoperative to the postoperative period in all urinary diversion groups. This study explored longitudinal changes in HRQOL after RC, and the findings may help inform patient counseling regarding possible QOL trajectories.
DOI： 10.1111/cas.70289
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Shimizu S., Osawa T., Sato M., Yamada S., Harabayashi T., Miki J., Kobayashi T., Hashine K., Kawashima A., Matsumoto T., Mochizuki T., Taoka R., Urabe F., Tatarano S., Sawada A., Kojima T., Takahashi A., Yokomizo A., Suekane S., Hashimoto K., Hashimoto Y., Yatsuda J., Morita K., Kobayashi K., Satake Y., Sazawa A., Matsui Y., Ito Y.M., Nishiyama H., Kitamura H., Shinohara N., Fukuhara S.
International Journal of Urology 33 ( 2 ) e70364 2026.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Urology
Objectives: To validate, for the first time in patients with bladder cancer who underwent radical cystectomy, the recently developed 7-item Quality of Life Disease-specific Impact Scale (QDIS-7), a brief, unidimensional instrument designed for cross-condition comparisons. Methods: In this cross-sectional study conducted at 24 facilities, patients aged ≥ 20 years who were 3 months post-radical cystectomy for bladder cancer completed self-reported questionnaires. The enrollment period was from January 2020 to October 2022. Quality of life measures included the QDIS-7, the Bladder Cancer Index (BCI), and the Body Image Scale (BIS). Confirmatory factor analysis was performed to test the hypothesized one-factor structure of the QDIS-7. Internal consistency reliability was assessed using Cronbach's alpha coefficient. Criterion-based validity was evaluated using Spearman's correlation coefficients (ρ) between the QDIS-7 scores and the BCI bother subdomains and BIS scores. Results: In total, 205 patients (median age, 71 years; 78.5% male) were included. The QDIS-7 score showed no floor or ceiling effects. Confirmatory factor analysis supported the one-factor model (factor loadings, 0.71–0.94). Internal consistency reliability was high (Cronbach's alpha, 0.94). The QDIS-7 score showed moderate correlations with the BIS and the BCI urinary and bowel bother subdomain scores (ρ = 0.654, −0.560, and −0.475, respectively). Conclusions: The QDIS-7 effectively captured urinary and bowel symptom burden and body image impairment in patients undergoing radical cystectomy for bladder cancer. Its brevity, strong psychometric properties, and capacity for comparisons across conditions support its use in patient-centered research. Trail Registration: UMIN-CTR (UMIN000039538).
DOI： 10.1111/iju.70364
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Ueda K., Kurata H., Murakami Y., Minato A., Shiota M., Nakanishi S., Kiyoshima K., Inoue T., Kumagae H., Irie S., Noguchi M., Tatarano S., Matsuzaki H., Tokuda Y., Sawada A., Abe T., Oshiro Y., Harada S., Igawa T.
International Journal of Clinical Oncology 31 ( 1 ) 160 - 171 2026.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Clinical Oncology
Background: Patients with advanced renal cell carcinoma (RCC) undergoing hemodialysis are often excluded from clinical trials. We aimed to evaluate real-world outcomes of first-line molecular targeted therapy (MTT) and immuno-oncology (IO) combination therapies in patients with advanced RCC receiving hemodialysis. Methods: We retrospectively analyzed data from 88 patients undergoing hemodialysis who received first-line systemic therapy for advanced RCC at 18 institutions in Japan between 2008 and 2023. Patients were divided into three groups by first-line regimen: MTT (n = 53), IO–IO (n = 18), or IO–tyrosine kinase inhibitor (IO–TKI, n = 17). Treatment response, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were evaluated. Prognostic factors were identified using univariate and multivariate Cox regression analyses. Results: The median PFS and OS were 3.9 and 18.9 months, respectively. The IO–IO and IO–TKI groups achieved significantly longer PFS than that in the MTT group (median PFS 3.5, 5.4, and 7.5 months, respectively; p = 0.003); OS did not differ significantly between the groups. Grade ≥ 3 TRAEs occurred in 30.2%, 33.3%, and 41.2% of the MTT, IO–IO, and IO–TKI groups, respectively. Multivariate analysis identified poor Eastern Cooperative Oncology Group performance status, longer hemodialysis duration (≥ 10 years), and first-line regimen as independent PFS predictors. International Metastatic RCC Database Consortium risk classification and hemodialysis duration independently predicted OS. Conclusions: Systemic therapy, including IO–IO and IO–TKI regimens, demonstrated acceptable safety profiles for patients with advanced RCC undergoing hemodialysis. IO combination therapy significantly improved PFS, supporting its utility as a first-line treatment option.
Grant-in-Aid for Scientific Research 【 display / non-display 】
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ロボット手術鉗子による臓器圧迫程度を映像のみから判断し警告する安全システムの開発
Grant number：25K15959 2025.04 - 2028.03
独立行政法人日本学術振興会 科学研究費基金 基盤研究(C)
Authorship：Coinvestigator(s)
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ロボット支援腎部分切除・前立腺全摘除に適した3Dナビゲーションシステムの開発と検証
Grant number：24K07407 2024.04 - 2027.03
独立行政法人日本学術振興会 科学研究費基金 基盤研究(C)
Authorship：Coinvestigator(s)
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腎癌手術における腫瘍位置を可視化するナビゲーションシステムを完成させる
Grant number：24K12487 2024.04 - 2027.03
独立行政法人日本学術振興会 科学研究費基金 基盤研究(C)
Authorship：Principal investigator