Background Postoperative regional nodal irradiation (RNI) is a standard treatment for breast cancer at high risk of regional recurrence; however, the necessity of including the internal mammary node (IMN) region in the radiation field remains unclear. This study aimed to evaluate treatment outcomes in a large cohort of patients who received postoperative radiotherapy with RNI excluding the IMN region. Methods This study included patients with breast cancer who underwent surgery followed by RNI without IMN irradiation between 2007 and 2018. The primary endpoint was disease-free survival (DFS), and the secondary endpoints were overall survival (OS), breast cancer-specific mortality (BCM), distant metastasis-free survival (DMFS), recurrence patterns, and treatment-related adverse events. Results In total, 799 patients were included. The 5-year DFS, OS, BCM, and DMFS rates were 75.9, 88.3, 9.7, and 77.1%, respectively. Worse outcomes were associated with a higher number of positive lymph nodes and estrogen receptor (ER)-negative disease. Medial/central tumor location and younger age were each significantly associated with poorer outcomes, being associated with worse DFS and DMFS. Bone was the most common recurrence site. ER-negative disease, a higher number of positive lymph nodes, medial/central location, and younger age were significant risk factors for recurrence, particularly distant metastasis. IMN recurrence was rare. Conclusions In this cohort, medial/central tumor location, ER-negative disease, and extensive nodal involvement were associated with poorer outcomes, suggesting that these factors may identify patients who can benefit from IMN irradiation. These findings may serve as important reference data when determining the indication for IMN irradiation on an individual patient basis.
Background: Previous randomized clinical trials did not support a benefit of screening for occult cancer after diagnosis of venous thromboembolism (VTE), although screening may be of potential benefit for selected high-risk patients. Methods and Results: The COMMAND VTE Registry-2 enrolled consecutive patients with acute symptomatic VTE between 2015 and 2020 from 31 centers across Japan. The 3,706 patients in the registry without known active cancer at the time of VTE diagnosis were divided into 2 groups: those with (n=250) and without (n=3,456) newly diagnosed cancer during the follow-up period. The cumulative incidence of newly diagnosed cancer was 1.5% at 30 days, 3.7% at 1 year, and 7.0% at 3 years. The multivariable Cox proportional hazard model demonstrated that older age (hazard ratio [HR] 1.02 per 1 year increase; 95% confidence interval [CI] 1.01-1.03; P<0.001), a history of cancer (HR 3.57; 95% CI 2.73-4.64; P<0.001), autoimmune disorders (HR 1.48; 95% CI 1.06-2.02; P=0.02), a history of major bleeding (HR 1.64; 95% CI 1.04-2.48; P=0.04), and the absence of transient provoking risk factors for VTE (HR 1.44; 95% CI 1.08-1.92; P=0.01) were independently associated with newly diagnosed cancer. Conclusions: The incidence of newly diagnosed cancer after VTE diagnosis was 3.7% at 1 year, and several independent risk factors for newly diagnosed cancer after VTE diagnosis were identified.
Alpha-fetoprotein (AFP) is widely used as a tumor biomarker in the diagnosis and surveillance of hepatocellular carcinoma (HCC). AFP is a glycoprotein bearing N-linked glycans, and can be classified into three glycoforms: AFP-L1, AFP-L2, and AFP-L3. AFP-L3, the α(1,6)-fucosylated isoform, is regarded as a highly specific biomarker for HCC and is often associated with aggressive tumor biology. In contrast, AFP-producing gastric carcinoma (AFPGC) is rare, and few studies have examined the relationship between AFP-L3 and AFPGC. Here, we present a case who developed AFP-positive HCC without AFP-L3 elevation, and subsequently AFPGC showing marked elevation of the AFP-L3 fraction. This demonstrates that AFP-L3 elevation is not entirely specific to HCC and may also be observed in AFPGC. Furthermore, this case highlights that fucosylation activity may differ among AFP-producing tumors arising in different organs within the same individual.
AIM:The adoption of robot-assisted surgery (RAS) in Japan has progressed significantly since its initial approval in 2009. RAS gradually expanded into various surgical fields with 35 procedures now covered under Japan's national health insurance. This study provides an inaugural assessment of RAS outcomes for seven digestive procedures introduced in 2018. METHODS:The Japanese Society for Endoscopic Surgery working group established an RAS registry integrating data from the National Clinical Database and additional RAS-specific records. The analysis focused on three major gastrointestinal fields: the esophagus, stomach, and rectum. RESULTS:In 2019, 530 esophagectomies, 2295 gastrectomies, and 3269 proctectomies were performed. RAS for these procedures was characterized by relatively long operative times, low intraoperative blood loss, and very low conversion rates to open surgery (< 1%). Postoperative morbidity rates Grade IIIa or higher were 23.2% for esophagectomy, 4.9% for gastrectomy, and 9.4% for proctectomy. Length of postoperative hospital stay correlated with morbidity, though readmission (1.3%-3.1%) and postoperative mortality rates (0.3%-0.6%) remained low. The early nationwide implementation of RAS in Japan was marked by a high surgeon qualification rate (98.9%) and meticulous case selection; the DVSS Xi model accounted for 66.3% of robotic platforms used. CONCLUSION:These findings underscore the need for ongoing surveillance and data-driven evaluation to ensure safe and effective implementation of RAS. Future longitudinal analyses will refine surgical quality, optimize resource allocation, and advance minimally invasive techniques. This study highlights the transformative potential of RAS in Japanese surgical practice and its alignment with global trends.
To systematically review and meta-analyze the diagnostic accuracy of magnetic resonance imaging in differentiating uterine sarcomas from benign leiomyomas, thereby providing updated evidence for the revision of the Japan Radiological Society Diagnostic Imaging Guidelines. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies guidelines, a comprehensive literature search was performed by an independent information specialist to identify studies published between July 2019 and April 2025. Inclusion criteria required studies evaluating MRI (the combination of T2-weighted imaging and at least one additional sequence (diffusion-weighted imaging and/or contrast-enhanced imaging)) in patients with myometrial masses suspicious for sarcoma, with diagnostic performance assessable by 2 × 2 contingency tables. The reference standard was histopathology for malignant lesions, whereas benign diagnoses could be established by histopathology or by clinical/imaging follow-up. Data extraction and Quality Assessment of Diagnostic Accuracy Studies-2 quality assessment were performed independently. Pooled sensitivity and specificity were estimated using a random-effects model, and the hierarchical summary receiver operating characteristic (HSROC) curve was generated to estimate the area under the curve (AUC). Twelve studies met the inclusion criteria. All were retrospective, and substantial heterogeneity existed in patient selection and MRI protocols. The pooled sensitivity of MRI for diagnosing sarcoma was 84.2
