Updated on 2024/12/07

写真a

 
Kazusaka Hiroko
 
Affiliation
Nippon Medical School Hospital, Department of Endocrine Surgery, Assistant Professor
Title
Assistant Professor
External link

Research Areas

  • Life Science / General surgery and pediatric surgery

Papers

  • Patient-Reported Outcomes in Patients with Low-Risk Papillary Thyroid Carcinoma: Cross-Sectional Study to Compare Active Surveillance and Immediate Surgery International journal

    Hiroko Kazusaka, Iwao Sugitani, Kazuhisa Toda, Masaomi Sen, Marie Saito, Ryuta Nagaoka, Yusaku Yoshida

    World Journal of Surgery   47 ( 5 )   1190 - 1198   2022.10

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    Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

    BACKGROUND: This cross-sectional study compared patient-reported outcomes of low-risk papillary thyroid carcinoma (PTC, T1N0M0) between patients who underwent active surveillance (AS) and those who received immediate surgery, METHODS: Using the State-Trait Anxiety Inventory, Short-Form 36 version 2, and a visual analog scale for neck symptoms, 249 patients under AS and 32 patients underwent immediate surgery were compared. To match the difference in time from the onset of treatment to the survey, we conducted propensity score matching. We also investigated factors affecting anxiety in patients under AS in multiple linear regression analysis. RESULTS: In the entire group, patients under AS had significantly longer time from the onset to the survey than patients underwent immediate surgery (7.9 vs. 4.0 years). After matching, AS group showed significantly better trait anxiety and mental component summary (MCS) compared to surgery group, while surgery group showed better role-social component summary. AS group also had significantly better MCS than the Japanese norm-based score. Surgery group displayed worse neck symptoms than AS group. Among AS group, trait anxiety and time from the onset were significant predictors of state anxiety. Compared with the group with < 5 years since starting AS, the group with ≥ 5 years of follow-up showed a significantly better state anxiety only in patients with better trait anxiety. CONCLUSIONS: Low-risk PTC patients under AS showed better trait anxiety and mental health than surgery group. After a certain period, the anxiety of patients under AS seems to be improved, especially in patients with better trait anxiety.

    DOI： 10.1007/s00268-022-06786-5

    PubMed

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    Other Link： https://link.springer.com/article/10.1007/s00268-022-06786-5/fulltext.html

  • Long‐term outcomes of active surveillance for low‐risk papillary thyroid carcinoma: Progression patterns and tumor calcification

    Iwao Sugitani, Ryuta Nagaoka, Marie Saitou, Masaomi Sen, Hiroko Kazusaka, Mami Matsui, Takeshi Abe, Ryo Ito, Kazuhisa Toda

    World Journal of Surgery   2024.11

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    Publishing type：Research paper (scientific journal)   Publisher：Wiley  

    Abstract

    Introduction

    Active surveillance (AS) for low‐risk papillary thyroid carcinoma (PTC) is acknowledged as a valid management strategy. While older age is identified as a favorable factor for progression, long‐term evidence is scarce and lifelong monitoring has been deemed essential. This study investigated progression patterns and tumor calcification under long‐term AS and explored the possibility of ending follow‐up.

    Materials and Methods

    A total of 650 patients with low‐risk PTC who chose AS were enrolled. Progression was defined as either tumor enlargement (≥3 mm from initiation) or development of clinically apparent lymph node metastasis.

    Results

    The median observation period was 8 years; 45.2% were under surveillance for ≥10 years. Overall, 80 patients (12.3%) exhibited progression. Median age and observation period at the time of progression were 55 and 4 years, respectively. Only 2 patients showed progression after 15 years of follow‐up and 5 patients showed progression after reaching 80 years old. Among 71 patients experiencing tumor enlargement, surgery was performed immediately in 32 patients. The remaining 39 patients continued surveillance, but only 5 demonstrated ongoing enlargement thereafter. Of 40 surgeries due to progression, 36 were conducted within the first 10 years. The degree of calcification correlated with age and observation periods. No progression occurred after the development of rim calcification.

    Conclusions

    Progression during AS was extremely rare in older patients with long‐term surveillance and in tumors with rim calcification. It may be feasible to consider ending scheduled surveillance visits for these patients. Instances of progression halting after enlargement are not uncommon.

    DOI： 10.1002/wjs.12417

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  • Postoperative Bleeding Risk in Thyroid Surgery: Differences between Conventional and Endoscopic Video-Assisted Neck Surgery Methods

    Marie Saitou, Haruki Akasu, Tomoo Jikuzono, Masaomi Sen, Hiroko Kazusaka, Mami Matsui, Iwao Sugitani

    Journal of Nippon Medical School   91 ( 5 )   432 - 438   2024.10

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    Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

    DOI： 10.1272/jnms.jnms.2024_91-507

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  • Elevations of neutrophil-to-lymphocyte ratio and C-reactive protein over time as a precursor to anaplastic transformation of papillary thyroid carcinoma: a case report

    Masaomi Sen, Ryo Ito, Takeshi Abe, Hiroko Kazusaka, Mami Matsui, Marie Saitou, Ryuta Nagaoka, Tomoo Jikuzono, Iwao Sugitani

    Surgical Case Reports   10 ( 1 )   2024.8

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    Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

    Abstract

    Background

    Papillary thyroid carcinoma rarely undergoes anaplastic transformation. Some risk factors for anaplastic transformation of thyroid cancer are known, but such transformation is difficult to predict in practice. We report a case demonstrating elevations of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) over time as a precursor to anaplastic transformation of thyroid carcinoma.

    Case presentation

    The patient was an 89 year-old woman with a history of chronic aortic dissection. She was referred to our department after her local doctor detected thyroid nodules. She had previously been found to have multinodular goiter and enlarged left cervical lymph nodes on computed tomography. Her chief complaint was cervical discomfort and hoarseness. Blood tests revealed: white blood cells (WBCs), 4900 /µL; CRP, 0.29 mg/dL; neutrophils, 64.4%; and lymphocytes, 25.4%. A 21 mm mass was identified in the upper left lobe. Left III (16 mm) and left VI (16 mm) lymph node were enlarged on ultrasonography. Fine-needle aspiration cytology diagnosed malignant papillary carcinoma. However, due to the advanced age and medical history of the patient, a non-surgical policy was implemented. The primary tumor grew to 4 cm in diameter by 9 months after diagnosis, and blood tests showed: WBC, 7700 /µL; CRP, 0.18 mg/dL; neutrophils, 65.3%; and lymphocytes, 22.3%. By 10 months after diagnosis, the tumor had increased rapidly in diameter to 8 cm, with blood tests showing: WBC, 6500 /µL; CRP, 1.01 mg/dL; neutrophils, 68.2%; and lymphocytes, 19.3%. Anaplastic transformation of papillary thyroid carcinoma was diagnosed, and the patient was placed on treatment under a policy of best supportive care. Multiple lung metastases appeared 11 months after diagnosis, and blood test results showed: WBC, 13,300 /μL; CRP, 11.28 mg/dL; neutrophils, 93.6%; and lymphocytes, 2.3%. Unfortunately, the patient died of disease progression 63 days after identification of undifferentiated metastasis.

    Conclusions

    Chances to see the natural history of anaplastic transformation of thyroid cancer are rare. Elevations in NLR and CRP over time may be precursors to anaplastic transformation.

    DOI： 10.1186/s40792-024-01991-x

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    Other Link： https://link.springer.com/article/10.1186/s40792-024-01991-x/fulltext.html

  • 術前コントロールに難渋したバセドウ病の1例

    齋藤 麻梨恵, 軸薗 智雄, 長岡 竜太, 銭 真臣, 數阪 広子, 松井 満美, 竹内 晴紀, 小林 俊介, 木村 洸稀, 杉谷 巌

    日本内分泌学会雑誌   99 ( 5 )   1290 - 1290   2024.4

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    Language：Japanese   Publisher：(一社)日本内分泌学会  

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Misc.

  • Papillary thyroid carcinoma with squamous metaplasia mimicking anaplastic thyroid carcinoma: A case report

    數阪広子, 齋藤麻梨恵, 蛯名彩, 松井満美, 銭真臣, 長岡竜太, 呉壮香, 呉壮香, 大橋隆治, 杉谷巌

    日本内分泌外科学会雑誌   38 ( 2 )   114 - 118   2021

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    Language：Japanese  

    J-GLOBAL

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  • 甲状腺・副甲状腺内視鏡手術におけるエビデンス形成に必要なこと 内視鏡下甲状腺手術の標準化に向けて

    長岡 竜太, 伊藤 良, 阿部 武司, 數阪 広子, 松井 満美, 銭 真臣, 齋藤 麻梨恵, 軸薗 智雄, 赤須 東樹, 杉谷 巌

    日本内視鏡外科学会雑誌   28 ( 7 )   129 - 129   2023.12

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    Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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  • 甲状腺低リスク乳頭癌の1年間の経過におけるPRO検討 積極的経過観察法と即時手術法の比較

    數阪 広子, 伊藤 良, 松井 満美, 銭 真臣, 齋藤 麻梨恵, 長岡 竜太, 軸薗 智雄, 杉谷 巌

    日本医科大学医学会雑誌   19 ( 4 )   397 - 397   2023.12

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    Language：Japanese   Publisher：日本医科大学医学会  

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  • 未来へ向かう診断・治療 高リスク甲状腺乳頭癌に対する甲状腺温存による根治切除の長期成績

    杉谷 巌, 數阪 広子, 蛯名 彩, 戸田 和寿, 新橋 渉, 竹内 賢吾

    日本内分泌外科学会雑誌   39 ( Suppl.1 )   S97 - S97   2022.6

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    Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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  • 【甲状腺疾患の診断と治療】超低リスク乳頭癌の積極的経過観察(Active surveillance)

    數阪 広子, 杉谷 巌

    Vita   38 ( 4 )   42 - 47   2021.10

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    Language：Japanese   Publisher：(株)ビー・エム・エル  

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Awards

  • 研究奨励賞

    2024.5   日本内分泌外科学会  

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  • The Fujimoto Prize

    2023.3   Factors Affecting Individual Decision-Making: Patient-Reported Outcome (PRO) Study on Low-Risk PTC

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  • The Yokohama Award

    2022.8   Patient-Reported Outcomes in Patients with Low-Risk Papillary Thyroid Carcinoma: Cross-Sectional Study to Compare Active Surveillance and Immediate Surgery

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Research Projects

  • 甲状腺低リスク乳頭癌のアクティブ・サーベイランスにおけるベスト・プラクティス探求

    Grant number：23K08081  2023.4 - 2026.3

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    杉谷 巌, 軸薗 智雄, 長岡 竜太, 眞田 麻梨恵, 銭 真臣, 數阪 広子, 松井 満美

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    Grant amount：\4810000 （ Direct Cost: \3700000 、 Indirect Cost：\1110000 ）

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  • 甲状腺微小乳頭癌の個別的管理のためのバイオマーカー探索と患者報告アウトカム研究

    Grant number：20K08995  2020.4 - 2023.3

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    杉谷 巌, 石橋 宰, 軸薗 智雄, 吉田 有策, 呉 壮香, 長岡 竜太, 眞田 麻梨恵, 銭 真臣, 數阪 広子, 松井 満美

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    Grant amount：\4290000 （ Direct Cost: \3300000 、 Indirect Cost：\990000 ）

    低リスク微小乳頭癌の過剰治療予防策として提唱された積極的経過観察（Active surveillance：AS）について、治療を受ける患者側の視点から健康関連QOLを評価した患者報告アウトカム（Patient-reported outcome: PRO）研究を継続している。本研究はすでにASまたは手術を受けている患者を対象とする横断研究部分と、新しく低リスク微小乳頭癌と診断された患者を対象とする縦断研究部分から成る。
    横断研究部分について、1995年から2019年までに低リスク微小乳頭癌の診断を受け、管理継続中の282人の患者に対するPRO評価を行い、データの確認、統計解析を行った。管理方針はAS249例、手術33例（内視鏡手術9例を含む）であった。包括的QOL評価尺度としてSF-36v2、疾患特異的QOL尺度としてVisual Analog Scale (VAS）、不安尺度として新版STAIを用いた。女性が246例（87%）、平均年齢は49.9歳、治療開始からの経過年数の中央値はAS群7.9年、手術群4.0年であった。手術群に比較して、AS群はSTAIの状態不安（評価を行った時点での不安）、特性不安（もともと不安になりやすい特性）とも有意に良好であり、SF-36v2における「精神的側面のQOLサマリースコア」も有意に良好であった。さらに、SF-36v2の下位尺度8項目については、「社会生活機能」を除く7項目で、AS群は国民標準値を上回った。VASでは、手術群はAS群よりも頸部手術関連症状が不良であった。さらに、AS群における多変数解析の結果、特性不安と経過観察期間が状態不安と有意に相関することが確認された。経過観察期間が5年以上の患者は5年未満の患者に比べ、有意に状態不安が軽減した。
    縦断研究部分も2020年4月より開始しており、すでに100例を超える患者を登録した。

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