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•Pro...
