BACKGROUND:Percutaneous transluminal angioplasty (PTA) effectively treats hemodialysis access stenosis; however, restenosis remains common, partly due to variability in balloon diameter selection. To address this issue, we evaluated the utility of a simple +1-mm upsizing strategy using the same balloon type. METHODS:This retrospective cohort study was conducted at Tokai Central Hospital between September 2021 and August 2025. We analyzed 17 PTA procedures in 15 maintenance hemodialysis patients who underwent regularly scheduled PTA for recurrent stenosis. To minimize device-related variability, only sessions in which the same balloon type was used and upsized by +1 mm were included. Vascular resistance, blood flow, and vessel diameter were assessed by duplex ultrasonography following a standardized protocol. RESULTS:No adverse events occurred. Balloon upsizing significantly improved vascular resistance and vessel diameter, demonstrated a trend toward increased blood flow, and showed a tendency to prolong the interval between PTA sessions. CONCLUSIONS:A +1-mm balloon upsizing strategy improves hemodynamics without increasing complications and may represent a safe, practical enhancement to PTA management of hemodialysis access.
Sentinel node biopsy (SNB) has been the standard of care for patients with clinically node-negative breast cancer (BC) since the 2000s. Recent ASCO guidelines now permit SNB to be omitted under specific conditions in clinical T1N0 BC. While axillary lymph node dissection (ALND) remains a regional control option for early BC, optimal axillary management, including repeat SNB, for ipsilateral breast tumor recurrence (IBTR) remains undefined. To address this, the Japanese Society for Sentinel Node Navigation Surgery (SNNS), established in 1999 to advance sentinel node research in solid tumors, conducted a retrospective cohort study (UMIN No. 000049737) on axillary management in IBTR cases. We included patients with clinical Tis-4N0 BC who underwent partial mastectomy and SNB, and whose IBTR was diagnosed between January 2010 and August 2022. Exclusion criteria included clinically node-positive BC, bilateral BC, and stage IV BC. Adjuvant therapy decisions were at the physician's discretion. We analyzed clinicopathological data, focusing on lymphatic mapping and repeat SNB, from primary BC and IBTR medical records. This study received approval from the Kyorin University School of Medicine institutional review board. Our study enrolled 314 eligible cases from 20 Japanese institutions. At primary BC diagnosis, 66 cases were stage 0, 178 were stage IA/B, 66 were stage IIA/B, 1 was stage IIIA, and 3 had unknown stages. SNB was successful in 312 cases (99.3%), with only 12 cases (3.8%) showing positive sentinel lymph nodes (SLN). Breast and regional nodal irradiation were performed in 237 and 8 cases, respectively. IBTR was diagnosed between 3 and 259 months (median: 70 months) after primary BC surgery. Total mastectomy was planned for 243 cases, and partial mastectomy for 64. Sixteen cases also underwent breast reconstruction. Repeat SNB was performed in 216 cases (68.7%), with successful SLN identification in 181 (83.7%). Of the 168 cases that underwent radioisotope-guided lymphatic mapping, hot spots were visualized in 112 (66.6%) via lymphoscintigraphy. SLN localization showed 175 in the ipsilateral axilla, 6 in the contralateral axilla, and 4 in the ipsilateral internal mammary lesion. Positive SLN rates were 9.1% (11 cases) for ipsilateral axilla, 1.6% (1 case) for contralateral axilla, and 0% (0 cases) for ipsilateral internal mammary lesion. Following axillary management for IBTR, repeat SNB was performed in 194 cases (61.7%), lymph node sampling in 2 (0.6%), ALND in 37 (11.7%), and no axillary surgery in 81 (25.7%). Post-IBTR axillary management, 20 cases experienced regional or contralateral lymph node recurrence, and 23 cases died. Repeat SNB is feasible and provides valuable information for de-escalation surgery in IBTR cases. However, axillary management should be carefully considered, taking into account both loco-regional and systemic dissemination at the time of IBTR diagnosis. T. Nakayama, R. Nakamura, T. Onishi, H. Yasojima, J. Ando, H. Jinno, T. Ogawa, T. Aihara, H. Matsumoto, N. Masuda, M. Kawada, S. Kuba, Y. Shinden, N. Wada, M. Kitada, M. Saito-Oba, J. Sakamoto, S. Imoto. A retrospective cohort study on axilla management in ipsilateral breast tumor recurrence after partial mastectomy with sentinel node biopsy [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-01-27.
BACKGROUND AND AIMS:Helicobacter pylori (H. pylori) eradication is crucial for gastric cancer (GC) prevention. However, increasing clarithromycin (CLR) resistance (CLRR) poses significant challenges. This study aimed to investigate CLRR patterns across different gastric diseases in Uzbekistan. METHODS:We retrospectively analyzed 279 H. pylori-infected patients with chronic non-atrophic gastritis (CNAG), chronic atrophic gastritis (CAG), gastric ulcer (GU), mucosa-associated lymphoid tissue lymphoma (MALT-L), or GC between 2020-2022. Among 194 cagA-positive patients who received eradication therapy, CLRR was defined by 23S rRNA mutations (A2142G, A2142C, A2143G) or treatment failure with CLR-based regimens. Logistic regression identified factors associated with CLRR, evaluated by univariate and multivariate analysis, and predicted probability models were generated based on disease type and patient characteristics. RESULTS:The overall CLRR rate was 44.8% (87/194), with 41.2% showing genotypic resistance. CLRR rates increased with disease severity: CNAG (33.3%), CAG (31.7%), GU (59.3%), MALT-L (54.1%), and GC (69.6%). Multivariate analysis identified older age (OR=2.27, 95%CI: 1.05-5.10), GU (OR=2.65, 95%CI: 1.04-6.96), and GC (OR=3.73, 95%CI: 1.34-11.2) as independent CLRR predictors. Disease-specific patterns emerged: GU and GC showed positive associations between age / body mass index and CLRR probability, while MALT-L demonstrated inverse relationships. CONCLUSIONS:High CLRR rates in Uzbekistan correlate with gastric disease severity. The disease-specific CLRR probability patterns identified in our study provide a practical framework for optimizing empirical therapy selection when comprehensive resistance testing is unavailable.
Trastuzumab deruxtecan (T-DXd) has been approved for the treatment of human epidermal growth factor receptor-2 (HER2)-positive gastric cancer and other indications in several countries and is considered moderately or highly emetogenic. The management of nausea and vomiting associated with T-DXd treatment has not been fully evaluated and the effectiveness of conventional prophylaxis remains unknown. This open-label, randomized, multicenter, phase 2 study aimed to investigate the optimal antiemetic therapy for Japanese patients with gastric cancer undergoing T-DXd treatment. Patients were randomized to a doublet regimen group (dexamethasone and palonosetron) or triplet regimen group (aprepitant, dexamethasone, and palonosetron) at a ratio of one to one, stratified by sex, gastrectomy status, and study institution. Both antiemetic treatments were administered from day 1 before T-DXd administration, and emetic events and nausea were observed for 21 days. The primary endpoint was the antiemetic complete response (CR) rate to assess control for emetic events based on voluntary patient-reported outcomes (PROs) during cycle 1 (1–21 days). Of the 60 enrolled patients, 58 were eligible for inclusion in this analysis (29 patients in each regimen group). The overall CR rates for the doublet and triplet regimens were 41.4
The Japanese Society for Sentinel Node Navigation Surgery conducted a multi-institutional prospective cohort study to compare sentinel node biopsy (SNB) with SNB followed by axillary lymph node dissection (ALND) in breast cancer patients with positive sentinel lymph node (SLN). Female patients with breast cancer with cT1-3N0-1M0 were eligible. In cases of one to three positive micro- or macrometastases in the SLN confirmed by histological or molecular diagnosis, SNB alone (SNB group) or additional ALND (ALND group) was performed under physician’s discretion. The primary endpoint was the 5-year regional node (RN) recurrence rate in the SNB group. Propensity score matching (PSM) was performed to compare the prognosis between the two groups. Of the 871 eligible cases registered between 2013 and 2016, 308 underwent SNB alone. At the median follow-up of 6.3 years, 5-year RN recurrence rate was 2.7
