1、The Role of Lymphadenectomy in Bladder Cancer,John P.Stein,M.D.University of Southern California Keck School of Medicine,Norris Comprehensive Cancer Center,Los Angeles CA,第一页，共八十七页。,第二页，共八十七页。,HIGH-GRADE,INVASIVE BLADDER CANCER Reality,“Invasive bladder cancer is a lethal disease.”,第三页，共八十七页。,USC BL
2、ADDER CANCER EXPERIENCE Rationale for Cystectomy,Best survival resultsLowest local recurrence ratesImproved morbidity and mortalityUrinary reconstruction has improved quality of life(continent and orthotopic diversion)Equally effective forms of therapy have not emerged,第四页，共八十七页。,USC/NORRIS BLADDER
3、CANCER EXPERIENCERecurrence-Free Survival of 1054 Patients Stratified by Lymph Node Status(LN+vs.LN-),(6/71-12/97),0,5,10,15,Years from Cystectomy,0.00,0.10,0.20,0.30,0.40,0.50,0.60,0.70,0.80,0.90,1.00,Probability of Not Recurring,LN+(n=244),LN-(n=810),P0.001,第五页，共八十七页。,Incidence of Lymph Node Metas
4、tases at Cystectomy,Author Years Total#Pts LN+Poulsen 90-97191 50(26%)Vieweg 80-90686 193(28%)Leissner 99-02290 81(28%)Stein 71-97 1054 246(24%)Totals 2221 570(25%),第六页，共八十七页。,第七页，共八十七页。,Risk Factors for Lymph Node Metastases Following Radical Cystectomy:The Concept of Lymph Node Density,John P.Stei
5、n,M.D.University of Southern California Keck School of Medicine,Norris Comprehensive Cancer Center,Los Angeles CA,第八页，共八十七页。,USC Radical Cystectomy Experience:Long-Term Results in 1,054 PatientsJ.Clin.Oncol.,19:666,2001.,Radical cystectomy with BPLND24%of patients LN+diseaseRisk factors include:p-st
6、age#of LN involved,第九页，共八十七页。,USC Radical Cystectomy Experience:Long-Term Results in 1,054 PatientsJ.Clin.Oncol.,19:666,2001.,Radical cystectomy with BPLND24%of patients LN+diseaseRisk factors include:p-stage#of LN involved,第十页，共八十七页。,USC Radical Cystectomy Experience:Long-Term Results in 1,054 Pati
7、entsJ.Clin.Oncol.,19:666,2001.,Radical cystectomy with BPLND24%of patients LN+diseaseRisk factors include:p-stage#of LN involved,第十一页，共八十七页。,USC Radical Cystectomy Experience:Long-Term Results in 1,054 PatientsJ.Clin.Oncol.,19:666,2001.,Radical cystectomy with BPLND24%of patients LN+diseaseRisk fact
8、ors include:p-stage#of LN involved,第十二页，共八十七页。,Radical Cystectomy Extent of Lymphadenectomy,Prognostic factors in LN-disease:Herr et al,J Urol,167 1298,2002Poulsen et al,J Urol,160,2015,2002Leissner et al,Br J Urol,85,817,2000,第十三页，共八十七页。,Radical Cystectomy Extent of Lymphadenectomy,Prognostic facto
9、rs in LN-disease:Herr et al,J Urol,167 1298,2002Poulsen et al,J Urol,160,2015,2002Leissner et al,Br J Urol,85,817,2000,第十四页，共八十七页。,Radical Cystectomy Extent of Lymphadenectomy,Prognostic factors in LN-disease:Herr et al,J Urol,167 1298,2002Poulsen et al,J Urol,160,2015,2002Leissner et al,Br J Urol,8
10、5,817,2000,第十五页，共八十七页。,Radical Cystectomy Extent of Lymphadenectomy,Prognostic factors in LN-disease:Herr et al,J Urol,167 1298,2002Poulsen et al,J Urol,160,2015,2002Leissner et al,Br J Urol,85,817,2000,第十六页，共八十七页。,Lymph Node Positive Bladder Cancer Lymph Node Density,Novel concept#of involved LN/#o
11、f LN removedAccounts for:1.LN tumor burden2.Extent of PLND,第十七页，共八十七页。,USC/Norris Lymph Node Positive Bladder Cancer ExperiencePurpose,1.Evaluate the clinical outcomes and risk factors for patients with lymph node metastases following radical cystectomy.2.Evaluate the concept of lymph node density(#
12、positive lymph nodes/#lymph nodes removed).,第十八页，共八十七页。,USC/Norris Lymph Node Positive Bladder Cancer ExperiencePatients,Time period:July 1971 Dec 1997Total lymph node+:244(24%)Gender:191 males(78%);53 females Age:median 66 years(range 36-90)Follow-up:median 10.1 years(range 0-26),第十九页，共八十七页。,USC BL
13、ADDER CANCER EXPERIENCE P-Stage and Lymph Node+,第二十页，共八十七页。,Pelvic Iliac Lymphadenectomy,第二十一页，共八十七页。,Pelvic Iliac Lymphadenectomy,第二十二页，共八十七页。,Pelvic Iliac Lymphadenectomy,第二十三页，共八十七页。,Pelvic Iliac Lymphadenectomy,第二十四页，共八十七页。,Obturator fossa,Pelvic Iliac Lymphadenectomy,Level of the inferior mesen
14、teric artery,第二十五页，共八十七页。,Obturator fossa,Pelvic Iliac Lymphadenectomy,Presacral lymph nodes,第二十六页，共八十七页。,第二十七页，共八十七页。,第二十八页，共八十七页。,第二十九页，共八十七页。,USC/Norris Lymph Node Positive Bladder Cancer ExperienceAdjuvant Therapies,Chemotherapy139 patients(56%)Postop-126(52%)Preop-7(3%)Pre&Postop-6(2%),Radiatio
15、n Therapy37 patients(15%)Preop-26(11%)Postop-8(3%)Pre&Postop-3(1%),第三十页，共八十七页。,USC/Norris Lymph Node Positive Bladder Cancer ExperienceLymph Nodes,Median#of LN removed:30(range 1-96)Median#of LN involved:2(range 1-63),30,2,第三十一页，共八十七页。,USC/Norris Lymph Node Positive Bladder Cancer ExperienceMorbidit
16、y and Mortality,2 perioperative deaths(1%)66 early complications(27%)No complication directly related to PLND,1,27,0,5,10,15,20,25,30,%,Morbidity,Mortality,第三十二页，共八十七页。,USC/Norris Lymph Node Positive Bladder Cancer ExperienceOutcomes Analysis,Presence of CisPrimary pathologic subgroupsTotal#of lymph nodes removedTotal#of lymph nodes involvedLymph node density(#+LN/#LN removed),第三十三页，共八十七页。,USC/Norris Lymph Node Positive Bladder Cancer ExperienceOutcomes Analysis,Presence of CisPrimary pathologic