Junichi Sakamoto

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.

Background/Objectives: This study aimed to assess the efficacy of adjuvant chemotherapy for T1-2 stage III colorectal cancer, a disease with a low recurrence rate. Methods: The efficacies of fluorouracil-based adjuvant chemotherapy (5FU group) and oxaliplatin-based adjuvant chemotherapy (L-OHP group) were assessed and compared with that of surgery alone (surgery group) using data from seven clinical trials conducted by the Japanese Foundation for Multidisciplinary Treatment of Cancer. Propensity score matching was used to compare the three groups. Direct-adjusted survival curves were delineated with consideration of treatment periods. Results: A total of 604 patients with T1-2 stage III colorectal cancer were identified. After adjusting for the patient factors, the hazard ratio of relapse-free survival (RFS) was 0.79 (95% confidence interval (CI): 0.13–4.65, p = 0.79) and 0.64 (95% CI: 0.06–6.40, p = 0.70) in the 5FU and L-OHP groups, respectively. Adjusted 5-year RFS rate was 82.8% (95% CI: 67.2–100%), 86.2% (95% CI: 74.2–100%), and 88.6% (95% CI: 74.0–100%) in the surgery, 5-FU, and L-OHP groups, respectively. Overall and disease-specific survival showed similar trends without significant differences. Conclusions: No significant improvement in prognosis was observed after adjuvant chemotherapy. The potential improvement in the 5-year RFS after adjuvant chemotherapy for resected T1-2 stage III colorectal cancer should be balanced with patient factors and adverse events.

Background: 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). Patients and methods: 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. Results: 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%. After PSM, 209 cases were matched in each group. Breast-conserving surgery and mastectomy were performed in 225 (54%) and 193 cases (46%), respectively. One-positive SLN was recorded in 366 cases (88%), two in 48 (11%), and three in 4 (1%). Macro- and micrometastases in SLN were diagnosed in 271 (65%) and 147 cases (35%), respectively. Regional nodal irradiation (RNI) was performed in 42 (20%) and 13 (6%) cases of the SNB and ALND group. The 5-year RN recurrence rate was 2.1% and 2.0%, respectively. Conclusions: ALND is not necessary for early breast cancer patients with one-positive SLN despite type of breast surgery.

Background Biweekly irinotecan plus cisplatin combination therapy (BIRIP) and irinotecan monotherapy (IRI) are both expectable second-line chemotherapy (SLC) options for treating advanced gastric cancer (AGC). Although many patients receiving SLC have undergone gastrectomy, the impact of gastrectomy on SLC remains unclear, and the impact of gastrectomy may vary from regimen to regimen. Patients and methods A total of 290 eligible patients registered in two randomized phase III trials evaluating BIRIP (IRI, 60 mg/m²; CDDP, 30 mg/m², q2w) or IRI (150 mg/m², q2w) for patients with AGC was classified into the prior gastrectomy subgroup (PGG) or the no gastrectomy subgroup (NGG). We performed a subgroup analysis to evaluate the impact of gastrectomy on second-line BIRIP and IRI. Results The BIRIP demonstrated significantly longer OS (11.1 vs. 6.8 months; HR 0.64; P = 0.026) and PFS (3.7 vs. 2.3 months; HR 0.54; P = 0.003) than the IRI, as well as better ORR (23.5% vs. 7.1%, P = 0.046) and DCR (74.5% vs. 47.6%, P = 0.010) in NGG. Although in PGG, the BIRIP failed to demonstrate differences in OS (13.8 vs. 13.8 months; HR 0.94; P = 0.722), PFS (4.9 vs. 4.5 months; HR 0.82; P = 0.194), ORR (18.3% vs. 20.5%) and DCR (70.4% vs. 65.1%). The incidence of grade 3 or worse adverse events did not differ except for a high incidence of anemia in the BIRIP group in PGG. Conclusions BIRIP was an effective treatment option that may improve survival outcomes among patients with AGC without previous gastrectomy. Clinical trial registration UMIN000025367.

It has been suggested that the therapeutic efficacy of S-1 + cisplatin (SP) and capecitabine + cisplatin (XP) may differ depending on the histology of the tumor, but no clear evidence exists. Individual participant data were obtained from three randomized phase II trials in which such patients received either SP (S-1 [40–60 mg twice daily for 21 days] plus cisplatin [60 mg/m² on day 8], every 5 weeks) or XP (capecitabine [1000 mg/m² twice daily for 14 days] plus cisplatin [80 mg/m² on day 1], every 3 weeks). A total of 162 patients were included, with 79 patients in the SP arm and 83 patients in the XP arm. Although there was also no difference between arms in ORR according to histological classification, differentiated tumors showed a significantly better OS (but not PFS) for SP versus XP that was associated with a deeper tumor shrinkage. Undifferentiated tumors showed a consistently better OS, and PFS for SP versus XP, likely because cases without tumor shrinkage tended to be fewer for SP. Our data thus showed that SP was superior to XP in this setting, but there were qualitative differences in therapeutic efficacy dependent on tumor histology.

This study aimed to investigate the relationship between working overtime and psychological stress reactions among school teachers. It also evaluated the interaction of overtime work types (on weekdays, on holidays, and bringing work home) and task content (educational, peripheral and both). This cross-sectional study was conducted on Japanese elementary and junior high school teachers. Primary outcome was psychological stress reactions measured with the Brief Job Stress Questionnaire. Participants were asked how long they work overtime on weekdays, holidays, and at home. Participants were also asked whether they engaged in educational tasks and/or peripheral tasks during that overtime work. Multiple linear regression analyses were applied and 6,135 participants were included in the analyses after imputing missing data. Working hours of all three types were significantly correlated with higher psychological stress reactions. Moreover, engaging in both educational and peripheral tasks showed higher psychological stress reactions than in only educational tasks when working overtime on weekdays and holidays. In conclusion, reducing overtime work regardless of work types is crucial for mitigating psychological stress reactions for teachers. It might also be possible to manage the psychological stress reactions by splitting the role of task contents, when working overtime on weekdays and holidays at school.

Сysts of the neck are congenital cystic lesions of the neck, often presenting in childhood. Complete surgical excision is the treatment of choice for these lesions. Recurrence of cystic lesions of the neck after incomplete excision is fraught with complications due to the need for a second surgery and complications of the recurrent cyst itself. We herein report the details of recurrent cysts of the neck presenting at 3, 6, 12 and 18 months postoperatively.

Cystic lesions of the head and neck are important entities that are being investigated increasingly frequently by cross-sectional imaging. Patients usually show neck swelling, and after initial clinical examinations, sonography may reveal the cystic nature of the lesion. Further imaging with magnetic resonance imaging (MRI) is often necessary to elucidate the etiology and lesion depth. This illustrated review describes the typical appearances and locations of a range of cystic lesions in the suprahyoid neck on MRI.