| Literature DB >> 31098822 |
Yuji Tachimori1, Soji Ozawa2, Hodaka Numasaki3, Ryu Ishihara4, Hisahiro Matsubara5, Kei Muro6, Tsuneo Oyama7, Yasushi Toh8, Harushi Udagawa9, Takashi Uno10.
Abstract
Entities:
Year: 2019 PMID: 31098822 PMCID: PMC6592979 DOI: 10.1007/s10388-019-00674-z
Source DB: PubMed Journal: Esophagus ISSN: 1612-9059 Impact factor: 4.230
Age and gender
| Age | Male | Female | Cases (%) |
|---|---|---|---|
| ≤ 29 | 3 | 1 | 4 (0.0%) |
| 30-39 | 16 | 14 | 30 (0.4%) |
| 40-49 | 163 | 58 | 221 (2.8%) |
| 50-59 | 1028 | 188 | 1216 (15.2%) |
| 60-69 | 2814 | 453 | 3267 (40.8%) |
| 70-79 | 2274 | 371 | 2645 (33.1%) |
| 80-89 | 476 | 118 | 594 (7.4%) |
| 90≤ | 18 | 8 | 26 (0.3%) |
| Total | 6792 | 1211 | 8003 |
Primary treatment
| Treatments | Cases (%) |
|---|---|
| Surgery | 4798 (60.0%) |
| Esophagectomy | 4722 (59.0%) |
| Palliative surgery | 76 (1.0%) |
| Chemotherapy/radiotherapy | 1794 (22.4%) |
| Endoscopic treatment | 1407 (17.6%) |
| Total | 7999 |
Tumor location
| Location of tumor | Endoscopic treatment (%) | Surgery | Chemotherapy and/or radiotherapy (%) | Total (%) | |
|---|---|---|---|---|---|
| Esophagectomy (%) | Palliative surgery (%) | ||||
| Cervical | 41 (2.9%) | 152 (3.2%) | 3 (3.9%) | 174 (9.7%) | 370 (4.6%) |
| Upper thoracic | 122 (8.7%) | 581 (12.3%) | 18 (23.7%) | 302 (16.8%) | 1023 (12.8%) |
| Middle thoracic | 819 (58.2%) | 2151 (45.6%) | 37 (48.7%) | 825 (46.0%) | 3832 (47.9%) |
| Lower thoracic | 335 (23.8%) | 1344 (28.5%) | 14 (18.4%) | 392 (21.9%) | 2085 (26.1%) |
| EG | 58 (4.1%) | 356 (7.5%) | 2 (2.6%) | 39 (2.2%) | 455 (5.7%) |
| E = G | 14 (1.0%) | 56 (1.2%) | 1 (1.3%) | 10 (0.6%) | 81 (1.0%) |
| GE | 4 (0.3%) | 59 (1.2%) | 1 (1.3%) | 7 (0.4%) | 71 (0.9%) |
| Unknown | 14 (1.0%) | 23 (0.5%) | 45 (2.5%) | 82 (1.0%) | |
| Total | 1407 | 4722 | 76 | 1794 | 7999 |
E esophageal, G gastric
Histologic types of biopsy specimens
| Histologic types | Cases (%) |
|---|---|
| Squamous cell carcinoma | 7162 (89.5%) |
| Squamous cell carcinoma | 5130 (64.1%) |
| Well differentiated | 440 (5.5%) |
| Moderately differentiated | 1177 (14.7%) |
| Poorly differentiated | 415 (5.2%) |
| Adenocarcinoma | 358 (4.5%) |
| Barrett’s adenocarcinoma | 119 (1.5%) |
| Adenosquamous carcinoma | 15 (0.2%) |
| Mucoepidermoid carcinoma | 6 (0.1%) |
| Basaloid carcinoma | 41 (0.5%) |
| Neuroendocrine cell tumor | 24 (0.3%) |
| Undifferentiated carcinoma | 12 (0.2%) |
| Sarcoma | 79 (1.0%) |
| Malignant melanoma | 1 (0.0%) |
| Carcinosarcoma | 19 (0.2%) |
| GIST | 14 (0.2%) |
| Other tumors | 2 (0.0%) |
| Unknown | 147 (1.8%) |
| Total | 7999 |
Depth of tumor invasion, cT (UICC TNM 7th)
| cT | Cases (%) |
|---|---|
| cTX | 100 (1.3%) |
| cT0 | 14 (0.2%) |
| cTis | 216 (2.7%) |
| cT1a | 1264 (15.8%) |
| cT1b | 1575 (19.7%) |
| cT2 | 1004 (12.6%) |
| cT3 | 2843 (35.5%) |
| cT4a | 395 (4.9%) |
| cT4b | 538 (6.7%) |
| Unknown | 50 (0.6%) |
| Total | 7999 |
Lymph node metastasis, cN (UICC TNM 7th)
| cN | Cases (%) |
|---|---|
| cNX | 170 (2.1%) |
| cN0 | 3796 (47.5%) |
| cN1 | 2020 (25.3%) |
| cN2 | 1335 (16.7%) |
| cN3 | 519 (6.5%) |
| Unknown | 159 (2.0%) |
| Total | 7999 |
Distant metastasis, cM (UICC TNM 7th)
| cM | Cases (%) |
|---|---|
| cM0 | 7214 (90.2%) |
| cM1 | 740 (9.3%) |
| Unknown | 45 (0.6%) |
| Total | 7999 |
Clinical stage (UICC TNM 7th)
| Clinical Stage | Endoscopic treatment(%) | Surgery | Chemotherapy and/or radiotherapy (%) | Total (%) | |
|---|---|---|---|---|---|
| Esophagectomy (%) | Palliative surgery (%) | ||||
| Stage 0 | 254 (18.1%) | 104 (2.2%) | 2 (2.6%) | 54 (3.0%) | 414 (5.2%) |
| Stage IA | 981 (69.7%) | 1117 (23.7%) | 1 (1.3%) | 201 (11.2%) | 2300 (28.8%) |
| Stage IB | 6 (0.4%) | 393 (8.3%) | 50 (2.8%) | 449 (5.6%) | |
| Stage IIA | 5 (0.4%) | 499 (10.6%) | 6 (7.9%) | 79 (4.4%) | 589 (7.4%) |
| Stage IIB | 3 (0.2%) | 458 (9.7%) | 88 (4.9%) | 549 (6.9%) | |
| Stage IIIA | 9 (0.6%) | 951 (20.1%) | 14 (18.4%) | 210 (11.7%) | 1184 (14.8%) |
| Stage IIIB | 10 (0.7%) | 510 (10.8%) | 6 (7.9%) | 117 (6.5%) | 643 (8.0%) |
| Stage IIIC | 20 (1.4%) | 384 (8.1%) | 26 (34.2%) | 418 (23.3%) | 848 (10.6%) |
| Stage IV | 36 (2.6%) | 183 (3.9%) | 16 (21.1%) | 505 (28.1%) | 740 (9.3%) |
| Unknown | 83 (5.9%) | 123 (2.6%) | 5 (6.6%) | 72 (4.0%) | 283 (3.5%) |
| Total | 1407 | 4722 | 76 | 1794 | 7999 |
Details of endoscopic treatment for curative intent
| Treatment details | Cases (%) |
|---|---|
| EMR | 185 (14.2%) |
| EMR + YAG laser | 6 (0.5%) |
| EMR + MCT/RFA | 1 (0.1%) |
| ESD | 1064 (81.9%) |
| ESD + EMR | 2 (0.2%) |
| ESD + PDT | 8 (0.6%) |
| ESD + YAG laser | 8 (0.6%) |
| PDT | 3 (0.2%) |
| YAG laser | 22 (1.7%) |
| Total | 1299 |
EMR endoscopic mucosal resection, PDT photodynamic therapy, YAG yttrium aluminum garnet, MCT microwave coagulation therapy, ESD endoscopic submucosal dissection
Complications of EMR/ESD
| Complications of EMR/ESD | Cases (%) |
|---|---|
| None | 1206 (94.7%) |
| Perforation | 20 (1.6%) |
| Bleeding | 1 (0.1%) |
| Stenosis | 35 (2.7%) |
| Others | 5 (0.4%) |
| Unknown | 7 (0.5%) |
| Total | 1274 |
Pathological depth of tumor invasion of EMR/ESD specimens
| Pathological depth of tumor invasion | Cases (%) |
|---|---|
| pTX | 6 (0.5%) |
| pT0 | 10 (0.8%) |
| pTis | 234 (18.4%) |
| pT1a | 873 (68.5%) |
| pT1b | 140 (11.0%) |
| pT2 | 2 (0.2%) |
| Unknown | 9 (0.7%) |
| Total | 1274 |
Fig. 1Survival of patients treated with EMR/ESD
Fig. 2Survival of patients treated with EMR/ESD according to the pathological depth of tumor invasion, pT (UICC TNM 7th)
Fig. 3Survival of patients treated with EMR/ESD according to the lymphatic and venous invasion
Dose of irradiation (non-surgically treated cases)
| Dose of irradiation (Gy) | Definitive | Palliative (%) | Recurrence (%) | Others (%) | Unknown (%) | Total (%) | |
|---|---|---|---|---|---|---|---|
| Radiation alone (%) | Chemoradiotherapy (%) | ||||||
| − 29 | 7 (3.2%) | 14 (1.5%) | 14 (4.5%) | 1 (3.3%) | 36 (2.4%) | ||
| 30–39 | 3 (1.4%) | 13 (1.4%) | 46 (14.7%) | 1 (20.0%) | 5 (16.7%) | 1 (2.5%) | 69 (4.6%) |
| 40–49 | 4 (1.9%) | 36 (4.0%) | 63 (20.1%) | 1 (20.0%) | 7 (23.3%) | 1 (2.5%) | 112 (7.4%) |
| 50–59 | 35 (16.2%) | 192 (21.2%) | 76 (24.3%) | 8 (26.7%) | 10 (25.0%) | 321 (21.3%) | |
| 60–69 | 127 (58.8%) | 546 (60.4%) | 103 (32.9%) | 3 (60.0%) | 7 (23.3%) | 27 (67.5%) | 813 (53.9%) |
| 70- | 7 (3.2%) | 30 (3.3%) | 4 (1.3%) | (0.0%) | 41 (2.2%) | ||
| Unknown | 33 (15.3%) | 73 (8.1%) | 7 (2.2%) | 2 (6.7%) | 1 (2.5%) | 116 (7.7%) | |
| Total | 216 | 904 | 313 | 5 | 30 | 40 | 1508 |
| Median (min–max) | 60.0 (2.0–139.0) | 60.0 (8.0–104.4) | 50.0 (2.0–126.0) | 60.0 (30.0–63.0) | 50.0 (4.5–63.0) | 60.0 (30.0–66.0) | 60.0 (2.0–139.0) |
Dose of irradiation (surgically treated cases)
| Dose of irradiation (Gy) | Preoperative irradiation (%) | Postoperative irradiation (%) |
|---|---|---|
| − 29 | 3 (1.0%) | 1 (1.8%) |
| 30–39 | 86 (28.6%) | 3 (5.4%) |
| 40–49 | 166 (55.1%) | 9 (16.1%) |
| 50–59 | 10 (3.3%) | 17 (30.4%) |
| 60–69 | 23 (7.6%) | 23 (41.1%) |
| 70– | ||
| Unknown | 13 (4.3%) | 3 (5.4%) |
| Total | 301 | 56 |
| Median (min–max) | 40.0 (3.0–66.6) | 50.5 (16.0–66.0) |
Fig. 4Survival of patients treated with chemotherapy and/or radiotherapy
Fig. 5Survival of patients treated with definitive chemoradiotherapy according to clinical stage (UICC TNM 7th)
Fig. 6Survival of patients treated with radiotherapy alone according to clinical stage (UICC TNM 7th)
Treatment modalities of esophagectomy
| Treatments | Cases (%) |
|---|---|
| Esophagectomy | 1792 (38.0%) |
| Esophagectomy + endoscopic treatment | 123 (2.6%) |
| Esophagectomy + chemoradiotherapy | 806 (17.1%) |
| Concurrent chemoradiotherapy | 557 (11.8%) |
| Other | 249 (5.3%) |
| Esophagectomy + chemoradiotherapy + endoscopic treatment | 24 (0.5%) |
| Esophagectomy + chemoradiotherapy + other treatment | 1 (0.0%) |
| Esophagectomy + radiotherapy | 67 (1.4%) |
| Preoperative | 15 (0.3%) |
| Postoperative | 23 (0.5%) |
| Recurrence | 4 (0.1%) |
| Other | 25 (0.5%) |
| Esophagectomy + chemotherapy | 1886 (39.9%) |
| Preoperative | 1473 (31.2%) |
| Postoperative | 253 (5.4%) |
| Recurrence | 52 (1.1%) |
| Other | 108 (2.3%) |
| Esophagectomy + chemotherapy + endoscopic treatment | 21 (0.4%) |
| Esophagectomy + chemotherapy + other treatment | 1 (0.0%) |
| Esophagectomy + other treatment | 1 (0.0%) |
| Total | 4722 |
Tumor location
| Locations | Cases (%) |
|---|---|
| Cervical | 152 (3.2%) |
| Upper thoracic | 581 (12.3%) |
| Middle thoracic | 2151 (45.6%) |
| Lower thoracic | 1344 (28.5%) |
| 356 (7.5%) | |
| 56 (1.2%) | |
| 59 (1.2%) | |
| Unknown | 23 (0.5%) |
| Total lesions | 4722 |
Approaches to tumor resection
| Approaches | Cases (%) |
|---|---|
| Cervical approach | 83 (1.8%) |
| Right thoracic | 4070 (86.2%) |
| Left thoracic | 81 (1.7%) |
| Left thoracoabdominal | 80 (1.7%) |
| Abdominal | 173 (3.7%) |
| Transhiatal thoracic esophagectomy | 59 (1.2%) |
| Transhiatal lower esophagectomy | 115 (2.4%) |
| Sternotomy | 9 (0.2%) |
| Others | 25 (0.5%) |
| Unknown | 27 (0.6%) |
| Total | 4722 |
Thoracic includes thoracotomy and thoracoscopic
Abdominal includes laparotomy and laparoscopic
Video-assisted surgery
| Video-assisted surgery | Cases (%) |
|---|---|
| None | 2623 (55.5%) |
| Thoracoscopy | 983 (20.8%) |
| Thoracoscopy + laparoscopy | 712 (15.1%) |
| Thoracoscopy + laparoscopy + mediastinoscopy | 3 (0.1%) |
| Thoracoscopy + laparoscopy + other | 1 (0.0%) |
| Thoracoscopy + mediastinoscopy | 3 (0.1%) |
| Thoracoscopy + other | 2 (0.0%) |
| Laparoscopy | 218 (4.6%) |
| Laparoscopy + mediastinoscopy | 11 (0.2%) |
| Laparoscopy + mediastinoscopy + other | 13 (0.3%) |
| Mediastinoscopy | 41 (0.9%) |
| Others | 107 (2.3%) |
| Unknown | 5 (0.1%) |
| Total | 4722 |
Fields of lymph node dissection according to the location of the tumor
| Field of lymphadenectomy | Cervical | Upper thoracic | Middle thoracic | Lower thoracic | Unknown | Total | |||
|---|---|---|---|---|---|---|---|---|---|
| None | 19 (12.5%) | 27 (4.6%) | 81 (3.8%) | 39 (2.9%) | 17 (4.8%) | 3 (5.4%) | 1 | 1 (4.3%) | 188 (4.0%) |
| C | 40 (26.3%) | 8 (1.4%) | 8 (0.4%) | 5 (0.4%) | (0.0%) | 61 (1.3%) | |||
| C + UM | 16 (10.5%) | 3 (0.5%) | 3 (0.1%) | 2 (0.1%) | 1 (1.8%) | 1 | 26 (0.6%) | ||
| C + UM + MLM | 11 (7.2%) | 25 (4.3%) | 43 (2.0%) | 18 (1.3%) | 1 (0.3%) | 98 (2.1%) | |||
| C + UM + MLM + A | 45 (29.6%) | 369 (63.5%) | 1103 (51.3%) | 506 (37.6%) | 39 (11.0%) | 3 (5.4%) | 1 (1.7%) | 6 (26.1%) | 2072 (43.9%) |
| C + UM + MLM + A + OT | 1 (0.1%) | 1 (0.0%) | |||||||
| C + UM + A | 3 (2.0%) | 5 (0.9%) | 1 (0.0%) | 2 (0.1%) | 11 (0.2%) | ||||
| C + MLM | 1(0.0%) | 1 (0.1%) | 2 (0.0%) | ||||||
| C + MLM + A | 4 (0.3%) | 7 (0.3%) | 5 (0.4%) | 1 (0.3%) | 17 (0.4%) | ||||
| C + A | 2 (1.3%) | 4 (0.2%) | 1 (0.1%) | 7 (0.1%) | |||||
| UM | 5 (0.2%) | 2 (0.1%) | 3 (0.8%) | 10 (0.2%) | |||||
| UM + MLM | 1 (0.7%) | 11 (1.9%) | 33 (1.5%) | 14 (1.0%) | 4 (1.1%) | 2 (8.7%) | 65 (1.4%) | ||
| UM + MLM + A | 10 (6.6%) | 110 (18.9%) | 768 (35.7%) | 595 (44.3%) | 115 (32.3%) | 11 (19.6%) | 7 (11.9%) | 8 (34.8%) | 1624 (34.4%) |
| UM + MLM + A + OT | 1 (0.1%) | 1 (0.0%) | |||||||
| UM + A | 7 (0.3%) | 3 (0.2%) | 1 (0.3%) | 11 (0.2%) | |||||
| MLM | 1 (0.2%) | 9 (0.4%) | 7 (0.5%) | 4 (1.1%) | 21 (0.4%) | ||||
| MLM + A | 8 (1.4%) | 45 (2.1%) | 105 (7.8%) | 129 (36.2%) | 26 (46.4%) | 27 (45.8%) | 2 (8.7%) | 342 (7.2%) | |
| A | 1 (0.7%) | 3 (0.5%) | 21 (1.0%) | 29 (2.2%) | 40 (11.2%) | 9 (16.1%) | 23 (39.0%) | 1 (4.3%) | 127 (2.7%) |
| A + OT | 1 (0.1%) | 1 (0.0%) | |||||||
| Unknown | 4 (2.6%) | 6 (1.0%) | 11 (0.5%) | 9 (0.7%) | 2 (0.6%) | 3 (5.4%) | 2 (8.7%) | 37 (0.8%) | |
| Total | 152 | 581 | 2151 | 1344 | 356 | 56 | 4722 |
C bilateral cervical nodes, UM upper mediastinal nodes, MLM middle-lower mediastinal nodes, A abdominal nodes
Reconstruction route
| Route | Cases (%) |
|---|---|
| None | 66 (1.4%) |
| Subcutaneous | 414 (8.8%) |
| Retrosternal | 1799 (38.1%) |
| Posterior mediastinal | 519 (11.0%) |
| Intrathoracic | 1794 (38.0%) |
| Cervical | 46 (1.0%) |
| Others | 49 (1.0%) |
| Unknown | 35 (0.7%) |
| Total | 4722 |
Organs used for reconstruction
| Organs used for reconstruction | Cases (%) |
|---|---|
| None | 62 (1.3%) |
| Whole stomach | 49 (1.0%) |
| Gastric tube | 4057 (85.0%) |
| Jejunum | 286 (6.0%) |
| Free jejunum | 94 (2.0%) |
| Colon | 157 (3.3%) |
| Free colon | 12 (0.3%) |
| Others | 24 (0.5%) |
| Unknown | 33 (0.7%) |
| Total organs | 4774 |
| Total cases | 4722 |
Histological classification
| Histological classification | Cases (%) |
|---|---|
| Squamous cell carcinoma | 3990 (84.5%) |
| Squamous cell carcinoma | 973 (20.6%) |
| Well differentiated | 713 (15.1%) |
| Moderately differentiated | 1788 (37.9%) |
| Poorly differentiated | 516 (10.9%) |
| Adenocarcinoma | 239 (5.1%) |
| Barrett’s adenocarcinoma | 109 (2.3%) |
| Adenosquamous carcinoma | 30 (0.6%) |
| Mucoepidermoid carcinoma | 5 (0.1%) |
| Adenoid cystic carcinoma | 3 (0.1%) |
| Basaloid carcinoma | 81 (1.7%) |
| Neuroendocrine cell tumor | 21 (0.4%) |
| Undifferentiated carcinoma | 12 (0.3%) |
| Other carcinoma | 6 (0.1%) |
| Carcinosarcoma | 36 (0.8%) |
| Malignant melanoma | 11 (0.2%) |
| GIST | 1 (0.0%) |
| Other | 46 (1.0%) |
| Unknown | 132 (2.8%) |
| Total | 4722 |
Pathological depth of tumor invasion, pT (JES 10th)
| Pathological depth of tumor invasion | Cases (%) |
|---|---|
| pTX | 71 (1.5%) |
| pT0 | 156 (3.3%) |
| pTis | 33 (0.7%) |
| pT1a | 503 (10.7%) |
| pT1b | 1256 (26.6%) |
| pT2 | 570 (12.1%) |
| pT3 | 1824 (38.6%) |
| pT4 | 20 (0.4%) |
| pT4a | 147 (3.1%) |
| pT4b | 103 (2.2%) |
| Unknown | 39 (0.8%) |
| Total | 4722 |
Pathological grading of lymph node metastasis, pN (JES 10th)
| Lymph node metastasis | Cases (%) |
|---|---|
| pN0 | 2237 (47.4%) |
| pN1 | 626 (13.3%) |
| pN2 | 1172 (24.8%) |
| pN3 | 393 (8.3%) |
| pN4 | 226 (4.8%) |
| Unknown | 68 (1.4%) |
| Total | 4722 |
Pathological findings of lymph node metastasis, pN (UICC 7th)
| Lymph node metastasis | Cases (%) |
|---|---|
| pN0 | 2164 (45.8%) |
| pN1 (1-2) | 1265 (26.8%) |
| pN2 (3-6) | 790 (16.7%) |
| pN3 (7-) | 392 (8.3%) |
| Unknown | 111 (2.4%) |
| Total | 4722 |
Regional lymph nodes are different in JES 10th and UICC 7th
Data for Tables 23 and 24 were analyzed from different variables in the registration application (Tables 25, 26, 27)
Pathological findings of distant organ metastasis, pM (JES 10th)
| Distant metastasis | Cases (%) |
|---|---|
| pMX | 172 (3.6%) |
| pM0 | 4490 (95.1%) |
| pM1 | 60 (1.3%) |
| Total | 4722 |
Residual tumor
| Residual tumor | Cases (%) |
|---|---|
| RX | 156 (3.3%) |
| R0 | 4160 (88.1%) |
| R1 | 216 (4.6%) |
| R2 | 190 (4.0%) |
| Total | 472 |
Causes of death
| Cause of death | Cases (%) |
|---|---|
| Death due to recurrence | 1383 (71.5%) |
| Death due to other cancer | 101 (5.2%) |
| Death due to other disease (with recurrence) | 46 (2.4%) |
| Death due to other disease (without recurrence) | 244 (12.6%) |
| Death due to other disease (recurrence unknown) | 19 (1.0%) |
| Operative deatha | 25 (1.3%) |
| Postoperative hospital deathb | 40 (2.1%) |
| Unknown | 77 (4.0%) |
| Total of death cases | 1935 |
Operative mortality rate: 0.52%
Hospital mortality rate: 2.35%
aOperative death means death within 30 days after operation in or out of hospital
bHospital death is defined as death during the same hospitalization, regardless of department at time of death
Fig. 7Survival of patients who underwent esophagectomy
Fig. 8Survival of patients who underwent esophagectomy according to clinical stage (JES 10th)
Fig. 9Survival of patients who underwent esophagectomy according to clinical stage (UICC 7th)
Fig. 10Survival of patients who underwent esophagectomy according to the depth of tumor invasion, pT (JES 10th)
Fig. 11Survival of patients who underwent esophagectomy according to lymph node metastasis, pN (JES 10th)
Fig. 12Survival of patients who underwent esophagectomy according to lymph node metastasis, pN (UICC 7th)
Fig. 13Survival of patients who underwent esophagectomy according to pathological stage (JES 10th)
Fig. 14Survival of patients who underwent esophagectomy according to pathological stage (UICC TNM 7th)
Fig. 15Survival of patients who underwent esophagectomy according to residual tumor (R)
| Institution |
|---|
| Ageo Central General Hospital |
| Aichi Cancer Center |
| Aichi Medical University Hospital |
| Aizawa Hospital |
| Akaishi Hospital |
| Akita Kouseiren Hiraga Hospital |
| Akita University Hospital |
| Aomori City Hospital |
| Arao Municipal Hospital |
| Asahikawa Medical College Hospital |
| Cancer Institute Hospital of JFCR |
| Chiba Cancer Center |
| Chiba Medical Center |
| Chiba University Hospital |
| Chibaken Saiseikai Narashino Hospital |
| Chigasaki Municipal Hospital |
| Dokkyo Medical University Hospital |
| Dokkyo Medical University Saitama Medical Center |
| Ehime University Hospital |
| Eiju General Hospital |
| Foundation for Detection of Early Gastric Carcinoma |
| Fuchu Hospital |
| Fujioka General Hospital |
| Fujisawa Shounandai Hospital |
| Fujita Health University Hospital |
| Fukui Prefectural Hospital |
| Fukui University Hospital |
| Fukui-ken Saiseikai Hospital |
| Fukuoka Dental College and Dental Hospital |
| Fukuoka Saiseikai General Hospital |
| Fukuoka University Chikushi Hospital |
| Fukuoka University Hospital |
| Fukuoka Wajiro Hospital |
| Fukushima Medical University Hospital |
| Fukuyama City Hospital |
| Fussa Hospital |
| Gifu Prefectural General Medical Center |
| Gifu University Hospital |
| Gunma Central General Hospital |
| Gunma Prefectural Cancer Center |
| Gunma University Hospital |
| Gunmaken Saiseikai Maebashi Hospital |
| Hachinohe City Hospital |
| Hakodate Goryokaku Hospital |
| Hakodate National Hospital |
| Hamamatsu University School of Medicine, University Hospital |
| Heartlife Hospital |
| Higashiosaka City Medical Center |
| Hino Memorial Hospital |
| Hino Municipal Hospital |
| Hiratsuka City Hospital |
| Hiratsuka Kyosai Hospital |
| Hirosaki University Hospital |
| Hiroshima City Asa Hospital |
| Hiroshima City Hiroshima Citizens Hospital |
| Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital |
| Hiroshima University Hospital |
| Hitachi General Hospital |
| Hokkaido University Hospital |
| Hyogo Cancer Center |
| Hyogo Prefectural Nishinomiya Hospital |
| Ibaraki Prefectural Central Hospital |
| Iizuka Hospital |
| Imazu Surgical Clinic |
| Inazawa City Hospital |
| International University of Health and Welfare Hospital |
| International Goodwill Hospital |
| International University of Health and Welfare Mita Hospital |
| Isehara Kyodo Hospital |
| Ishikawa Prefectural Central Hospital |
| Iwate Medical University Hospital |
| Iwate Prefectural Central Hospital |
| Iwate Prefectural Chubu Hospital |
| Iwate Prefectural Isawa Hospital |
| Japanese Red Cross Fukui Hospital |
| Japanese Red Cross Ishinomaki Hospital |
| Japanese Red Cross Kyoto Daini Hospital |
| Japanese Red Cross Nagaoka Hospital |
| Japanese Red Cross Okayama Hospital |
| Japanese Red Cross Society Kyoto Daiichi Hospital |
| Japanese Red Cross Tottori Hospital |
| JCHO Kurume General Hospital |
| JCHO Kyushu Hospital |
| JCHO Miyazaki Konan Hospital |
| JCHO Osaka Hospital |
| JCHO Saitama Medical Center |
| JCHO Tokuyama Central Hospital |
| JCHO Yokohama Chuo Hospital |
| Jichi Medical University Hospital |
| Jichi Medical University Saitama Medical Center |
| Juntendo University Hospital |
| Juntendo University Shizuoka Hospital |
| Junwakai Memorial Hospital |
| Kagawa Prefectural Central Hospital |
| Kagawa Rosai Hospital |
| Kagawa University Hospital |
| Kagoshima Kenritsu Satsunan Hospital |
| Kagoshima University Hospital |
| Kaizuka City Hospital |
| Kameda General Hospital |
| Kanagawa Cancer Center |
| Kanazawa University Hospital |
| Kansai Medical University Hospital |
| Kansai Medical University Medical Center |
| Kansai Rosai Hospital |
| Kasamatsu Hospital |
| Kashiwa Kousei General Hospital |
| Kawakita General Hospital |
| Kawasaki Medical School Hospital |
| Kawasaki Medical School Kawasaki Hospital |
| Kawasaki Municipal Ida Hospital |
| Keio University Hospital |
| Keiyukai Sapporo Hospital |
| Kikuna Memorial Hospital |
| Kin-ikyo Chuo Hospital |
| Kinki Central Hospital |
| Kinki University Hospital |
| Kiryu Kosei General Hospital |
| Kishiwada City Hospital |
| Kitaakita Municipal Hospital |
| Kitakyushu Municipal Medical Center |
| Kitano Hospital |
| Kitasato Institute Hospital |
| Kitasato University Hospital |
| Kobe City Medical Center General Hospital |
| Kobe City Nishi-Kobe Medical Center |
| Kobe University Hospital |
| Kochi Health Sciences Center |
| Kochi University Hospital |
| Kokura Memorial Hospital |
| Kumagaya General Hospital |
| Kumamoto City Hospital |
| Kumamoto University Hospital |
| Kurashiki Central Hospital |
| Kurume University Hospital |
| Kusatsu General Hospital |
| Kyorin University Hospital |
| Kyoto University Hospital |
| Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers |
| Kyushu Medical Center |
| Kyushu University Beppu Hospital |
| Kyushu University Hospital |
| Machida Municipal Hospital |
| Matsuda Hospital |
| Matsudo City Hospital |
| Matsushita Memorial Hospital |
| Matsuyama Red Cross Hospital |
| Mie University Hospital |
| Minamiosaka Hospital |
| Minamiyamato Hospital |
| Mino City Hospital |
| Mito Red Cross Hospital |
| Mitsui Memorial Hospital |
| Moriguchi Keijinkai Hospital |
| Murakami General Hospital |
| Musashino Red Cross Hospital |
| Nagahama City Hospital |
| Nagano Red Cross Hospital |
| Nagaoka Chuo General Hospital |
| Nagasaki University Hospital |
| Nagoya City East Medical Center |
| Nagoya City University Hospital |
| Nagoya City West Medical Center |
| Nagoya Daiichi Red Cross Hospital |
| Nagoya University Hospital |
| Nanpuh Hospital |
| Nara City Hospital |
| Nara Medical University Hospital |
| National Cancer Center Hospital |
| National Cancer Center Hospital East |
| National Defense Medical College Hospital |
| National Institute of Radiological Sciences Hospital |
| Nerima Hikarigaoka Hospital |
| NHO Beppu Medical Center |
| NHO Chiba Medical Center |
| NHO Chiba-East-Hospital |
| NHO Fukuoka-higashi Medical Center |
| NHO Himeji Medical Center |
| NHO Hokkaido Cancer Center |
| NHO Kanmon Medical Center |
| NHO Kure Medical Center |
| NHO Kyoto Medical Center |
| NHO Kyushu Cancer Center |
| NHO Matsumoto Medical Center |
| NHO Nagasaki Medical Center. |
| NHO Nagoya Medical Center |
| NHO Okayama Medical Center |
| NHO Osaka National Hospital |
| NHO Tokyo Medical Center |
| Nihonkai General Hospital |
| Niigata Cancer Center Hospital |
| Niigata City General Hospital |
| Niigata Prefectural Shibata Hospital |
| Niigata University Medical and Dental Hospital |
| Nikko Memorial Hospital |
| Nippon Medical School Chiba Hokusoh Hospital |
| Nippon Medical School Hospital |
| Nippon Medical School Musashi Kosugi Hospital |
| Nippon Medical School Tama Nagayama Hospital |
| Nishinomiya Municipal Central Hospital |
| NTT Medical Center Tokyo |
| NTT WEST Osaka Hospital |
| Numazu City Hospital |
| Obihiro Kousei Hospital |
| Ogachi Central Hospital |
| Ogaki Municipal Hospital |
| Ohta Nishinouchi Hospital |
| Oita Red Cross Hospital |
| Oita University Hospital |
| Okayama Saiseikai General Hospital |
| Okayama University Hospital |
| Omuta Tenryo Hospital |
| Osaka City General Hospital |
| Osaka City University Hospital |
| Osaka Ekisaikai Hospital |
| Osaka General Medical Center |
| Osaka International Cancer Institute |
| Osaka Medical College Hospital |
| Osaka Police Hospital |
| Osaka Red Cross Hospital |
| Osaka University Hospital |
| Otsu City Hospital |
| Rinku General Medical Center |
| Ryukyu University Hospital |
| Saga University Hospital |
| Saga-ken Medical Center Koseikan |
| Saiseikai Fukushima General Hospital |
| Saiseikai Kyoto Hospital |
| Saiseikai Utsunomiya Hospital |
| Saiseikai Yahata General Hospital |
| Saiseikai Yokohamashi Tobu Hospital |
| Saitama Cancer Center |
| Saitama City Hospital |
| Saitama Medical University Hospital |
| Saitama Medical University International Medical Center |
| Saitama Medical University Saitama Medical Center |
| Sakai City Medical Center |
| Saku Central Hospital |
| Sanin Rosai Hospital |
| Sendai City Hospital |
| Sendai Medical Center |
| Shiga General Hospital |
| Shiga University of Medical Science Hospital |
| Shikoku Cancer Center |
| Shimane University Hospital |
| Shimizu Welfare Hospital |
| Shinko Hospital |
| Shizuoka Cancer Center |
| Shizuoka City Shizuoka Hospital |
| Shizuoka General Hospital |
| Showa University Hospital |
| Showa University Koto-Toyosu Hospital |
| Sonoda Daiichi Hospital |
| Southern Tohoku General Hospital |
| St. Luke’s International Hospital |
| St. Marianna University School of Medical Hospital |
| Steel Memorial Hirohata Hospital |
| Sugita Genpaku Memorial Obama Municipal Hospital |
| Suita Municipal Hospital |
| Tachikawa Hospital |
| Takasago Municipal Hospital |
| Teikyo University Chiba Medical Center |
| Teikyo University Hospital |
| Teine Keijinkai Hospital |
| Tenri Hospital |
| The Jikei University Daisan Hospital |
| The Jikei University Hospital |
| Tochigi Cancer Center |
| Toho University Ohashi Medical Center |
| Toho University Omori Medical Center |
| Toho University Sakura Medical Center |
| Tohoku University Hospital |
| Tokai University Hachioji Hospital |
| Tokai University Hospital |
| Tokai University Tokyo Hospital |
| Tokushima Red Cross Hospital |
| Tokushima University Hospital |
| Tokyo Dental College Ichikawa General Hospital |
| Tokyo Medical and Dental University Hospital |
| Tokyo Medical University Hachioji Medical Center |
| Tokyo Medical University Hospital |
| Tokyo Medical University Ibaraki Medical Center |
| Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital |
| Tokyo Metropolitan Tama Medical Center |
| Tokyo Saiseikai Central Hospital |
| Tokyo University Hospital |
| Tokyo Women’s Medical University Hospital |
| Tokyo Women’s Medical University Medical Center East |
| Tokyo Women’s Medical University Yachiyo Medical Center |
| Tonan Hospital |
| Toranomon Hospital |
| Toshima Hospital |
| Tottori Prefectural Central Hospital |
| Tottori University Hospital |
| Toyama Prefectural Central Hospital |
| Toyama University Hospital |
| Toyonaka Municipal Hospital |
| Tsuchiura Kyodo Hospital |
| Tsukuba University Hospital |
| Tsuruoka Municipal Shonai Hospital |
| University Hospital, Kyoto Prefectural University of Medicine |
| University of Miyazaki Hospital |
| Urasoe General Hospital |
| Wakayama Medical University Hospital |
| Yamagata Prefectural Central Hospital |
| Yamagata Prefectural Shinjo Hospital |
| Yamagata University Hospital |
| Yamaguchi University Hospital |
| Yamaguchi-ken Saiseikai Shimonoseki General Hospital |
| Yamanashi Prefectural Central Hospital |
| Yamanashi University Hospital |
| Yao Municipal Hospital |
| Yokohama City Municipal Hospital |
| Yokohama City University Medical Center |
| Yokohama Rosai Hospital |
| Yuri Kumiai General Hospital |
(Total 316 institutions)