TheRoleofTheRoleofLymphadenectomyinLymphadenectomyinBladderCancerBladderCancerJohnP.Stein,M.D.JohnP.Stein,M.D.UniversityofSouthernCaliforniaKeckSchoolofUniversityofSouthernCaliforniaKeckSchoolofMedicine,NorrisComprehensiveCancerCenter,LosMedicine,NorrisComprehensiveCancerCenter,LosAngelesCAAngelesCA第一页，共八十七页。第二页，共八十七页。RealityReality““Invasivebladdercancerisalethaldisease.”Invasivebladdercancerisalethaldisease.”第三页，共八十七页。RationaleforCystectomyRationaleforCystectomy•BestsurvivalresultsBestsurvivalresults•LowestlocalrecurrenceratesLowestlocalrecurrencerates•ImprovedmorbidityandmortalityImprovedmorbidityandmortality•Urinaryreconstructionhasimprovedqualityoflife(continentandorthotopicdiversion)Urinaryreconstructionhasimprovedqualityoflife(continentandorthotopicdiversion)•EquallyeffectiveformsoftherapyhavenotemergedEquallyeffectiveformsoftherapyhavenotemerged第四页，共八十七页。USC/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<0.001第五页，共八十七页。IncidenceofLymphNodeMetastasesatIncidenceofLymphNodeMetastasesatCystectomyCystectomyAuthorYearsTotal#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%)第六页，共八十七页。第七页，共八十七页。RiskFactorsforLymphNodeRiskFactorsforLymphNodeMetastasesFollowingRadicalMetastasesFollowingRadicalCystectomy:TheConceptofCystectomy:TheConceptofLymphNodeDensityLymphNodeDensityJohnP.Stein,M.D.JohnP.Stein,M.D.UniversityofSouthernCaliforniaKeckSchoolofUniversityofSouthernCaliforniaKeckScho...
