TheRoleofLymphadenectomyinBladderCancerJohnP.Stein,M.D.UniversityofSouthernCaliforniaKeckSchoolofMedicine,NorrisComprehensiveCancerCenter,LosAngelesCA第一页，共八十七页。第二页，共八十七页。HIGH-GRADE,INVASIVEBLADDERCANCERReality“Invasivebladdercancerisalethaldisease.〞第三页，共八十七页。USCBLADDERCANCEREXPERIENCERationaleforCystectomy•Bestsurvivalresults•Lowestlocalrecurrencerates•Improvedmorbidityandmortality•Urinaryreconstructionhasimprovedqualityoflife(continentandorthotopicdiversion)•Equallyeffectiveformsoftherapyhavenotemerged第四页，共八十七页。USC/NORRISBLADDERCANCEREXPERIENCE(6/71-12/97)第五页，共八十七页。IncidenceofLymphNodeMetastasesatCystectomyAuthorYearsTotal#PtsLN+Poulsen‘90-’9719150(26%)Vieweg‘80-’90686193(28%)Leissner‘99-’0229081(28%)Stein‘71-’971054246(24%)Totals2221570(25%)第六页，共八十七页。第七页，共八十七页。RiskFactorsforLymphNodeMetastasesFollowingRadicalCystectomy:TheConceptofLymphNodeDensityJohnP.Stein,M.D.UniversityofSouthernCaliforniaKeckSchoolofMedicine,NorrisComprehensiveCancerCenter,LosAngelesCA第八页，共八十七页。USCRadicalCystectomyExperience:Long-TermResultsin1,054PatientsJ.Clin.Oncol.,19:666,2001.•RadicalcystectomywithBPLND•24%ofpatientsLN+disease•Riskfactorsinclude:p-stage#ofLNinvolved第九页，共八十七页。OrganConfined(n=594)Extravesical(n=214)LymphNode(+)(n=246)P<0.001ProbabilityofNotRecurringUSCRadicalCystectomyExperience:Long-TermResultsin1,054PatientsJ.Clin.Oncol.,19:666,2001.•RadicalcystectomywithBPLND••Riskfactorsinclude:p-stage#ofLNinvolved第十页，共八十七页。USCRadicalCystectomyExperience:Long-TermResultsin1,054PatientsJ.Clin.Oncol.,19:666,2001.•RadicalcystectomywithBPLND•24%ofpatientsLN+disease•Riskfactorsinclude:#ofLNinvolved第十一页，共八十七页。USCRadicalCystectomyExperience:Long-TermResultsin1,054PatientsJ.Clin.Oncol.,19:666,2001.•RadicalcystectomywithBPLND•24%ofpatientsLN+disease•Riskfactorsinclude:p-stage第十二页，共八十七页。RadicalCystectomyExtentofLymphadenectomy•PrognosticfactorsinLN-disease:•Herretal,JUrol,1671298,2002•Poulsenetal,JUrol,160,2022,2002•Leissneretal,BrJUrol,85,817,2000第十三页，共八十七页。RadicalCystectomyExtentofLymphadenectomy•PrognosticfactorsinLN-disease:•Herretal,JUrol,1671298,2002•Poulsenetal,JUrol,160,2022,2002•Leissneretal,BrJUrol,85,817,2000第十四页，共八十七页。RadicalCystectomyExtentofLymphadenectomy•PrognosticfactorsinLN-disease:•Herretal,JUrol,1671298,2002•Poulsenetal,JUrol,160,2022,2002•Leissneretal,BrJUrol,85,817,2000第十五页，共八十七页。RadicalCystectomyExtentofLymphadenectomy•PrognosticfactorsinLN-disease:•Herretal,JUrol,1671298,2002•Poulsenetal,JUrol,160,2022,2002•Leissneretal,BrJUrol,85,817,2000第十六页，共八十七页。LymphNodePositiveBladderCancerLymphNodeDensity•Novelconcept•#ofinvolvedLN/#ofLNremoved•Accountsfor:1.LNtumorburden2.ExtentofPLND第十七页，共八十七页。USC/NorrisLymphNodePositiveBladderCancerExperiencePurposeEvaluatetheclinicaloutcomesandriskfactorsforpatientswithlymphnodemetastasesfollowingradicalcystectomy.Evaluatetheconceptoflymphnodedensity(#positivelymphnodes/#lymphnodesremoved).第十八页，共八十七页。USC/NorrisLymphNodePositiveBladderCancerExperiencePatients•Timeperiod:July1971Dec1997•Totallymphnode+:•Gender:191males(78%);53females•Age:median66years(range36-90)•Follow-up:median10.1years(range0-26)第...
