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TheRoleofTheRoleofLymphadenectomyinLymphadenectomyinBladderCancerBladderCancerJohnP.Stein,M.D.JohnP.Stein,M.D.UniversityofSouthernCaliforniaKeckSchoolofUniversityofSouthernCaliforniaKeckSchoolofMedicine,NorrisComprehensiveCancerCenter,LosMedicine,NorrisComprehensiveCancerCenter,LosAngelesCAAngelesCAHIGH-GRADE,INVASIVEHIGH-GRADE,INVASIVEBLADDERCANCERBLADDERCANCERRealityReality““InvasivebladderInvasivebladdercancerisalethalcancerisalethaldisease.”disease.”USCBLADDERCANCERUSCBLADDERCANCEREXPERIENCEEXPERIENCERationaleforCystectomyRationaleforCystectomy•BestsurvivalresultsBestsurvivalresults•LowestlocalrecurrenceratesLowestlocalrecurrencerates•ImprovedmorbidityandmortalityImprovedmorbidityandmortality•UrinaryreconstructionhasimprovedqualityUrinaryreconstructionhasimprovedqualityoflife(continentandorthotopicdiversion)oflife(continentandorthotopicdiversion)•EquallyeffectiveformsoftherapyhavenotEquallyeffectiveformsoftherapyhavenotemergedemergedUSC/NORRISBLADDERCANCEREXPERIENCEUSC/NORRISBLADDERCANCEREXPERIENCERecurrence-FreeSurvivalof1054PatientsRecurrence-FreeSurvivalof1054PatientsStratifiedbyLymphNodeStatus(LN+vs.LN-)StratifiedbyLymphNodeStatus(LN+vs.LN-)(6/71-12/97)051015YearsfromCystectomy0.000.100.200.300.400.500.600.700.800.901.00ProbabilityofNotRecurringLN+(n=244)LN-(n=810)P<0.001IncidenceofLymphNodeIncidenceofLymphNodeMetastasesatCystectomyMetastasesatCystectomyAuthorYearsTotal#PtsAuthorYearsTotal#PtsLN+LN+PoulsenPoulsen‘90-’97‘90-’9719119150(26%)50(26%)ViewegVieweg‘80-’90‘80-’90686686193(28%)193(28%)Leissner‘99-’02Leissner‘99-’0229029081(28%)81(28%)SteinStein‘71-’97‘71-’9710541054246(24%)246(24%)TotalsTotals22212221570(25%)570(25%)RiskFactorsforLymphNodeRiskFactorsforLymphNodeMetastasesFollowingRadicalMetastasesFollowingRadicalCystectomy:TheConceptofCystectomy:TheConceptofLymphNodeDensityLymphNodeDensityJohnP.Stein,M.D.JohnP.Stein,M.D.UniversityofSouthernCaliforniaKeckSchoolofUniversityofSouthernCaliforniaKeckSchoolofMedicine,NorrisComprehensiveCancerCenter,Medicine,NorrisComprehensiveCancerCenter,LosAngelesCALosAngelesCAUSCRadicalCystectomyUSCRadicalCystectomyExperience:Long-TermResultsinExperience:Long-TermResultsin1,054Patients1,054PatientsJ.Clin.Oncol.,19:666,2001.J.Clin.Oncol.,19:666,2001.•RadicalcystectomyRadicalcystectomywithBPLNDwithBPLND•24%ofpatients24%ofpatientsLN+diseaseLN+disease•Riskfactorsinclude:Riskfactorsinclude:p-stagep-stage#ofLNinvolved#ofLNinvolvedOrganConfined(n=594)Extravesical(n=214)LymphNode(+)(n=246)P<0.001ProbabilityofNotRecurringUSCRadicalCystectomyUSCRadicalCystectomyExperience:Long-TermResultsinExperience:Long-TermResultsin1,054Patients1,054PatientsJ.Clin.Oncol.,19:666,2001.J.Clin.Oncol.,19:666,2001.•RadicalcystectomyRadicalcystectomywithBPLNDwithBPLND•24%ofpatients24%ofpatientsLN+diseaseLN+disease•Riskfactorsinclude:Riskfactorsinclude:p-stagep-stage#ofLNinvolved#ofLNinvolvedUSCRadicalCystectomyUSCRadicalCystectomyExperience:Long-TermResultsinExperience:Long-TermResultsin1,054Patients1,054PatientsJ.Clin.Oncol.,19:666,2001.J.Clin.Oncol.,19:666,2001.•RadicalcystectomyRadicalcystectomywithBPLNDwithBPLND•24%ofpatients24%ofpatientsLN+diseaseLN+disease•Riskfactorsinclude:Riskfactorsinclude:p-stagep-stage#ofLNinvolved#ofLNinvolvedUSCRadicalCystectomyUSCRadicalCystectomyExperience:Long-TermResultsinEx...