【正文】 Lymph Node Positive Bladder Cancer Experience Purpose Evaluate the clinical outes and risk factors for patients with lymph node metastases following radical cystectomy. Evaluate the concept of lymph node density ( positive lymph nodes/ lymph nodes removed). 第十八頁，共八十七頁。 Organ Confined (n=594) Extravesical (n=214) Lymph Node (+) (n=246) P Probability of Not Recurring USC Radical Cystectomy Experience: LongTerm Results in 1,054 Patients J. Clin. Oncol., 19: 666, 2024. ? Radical cystectomy with BPLND ? ? Risk factors include: ? pstage ? of LN involved 第十頁，共八十七頁。 第二頁，共八十七頁。 第七頁，共八十七頁。 Radical Cystectomy Extent of Lymphadenectomy ? Prognostic factors in LN disease: ? Herr et al, J Urol, 167 1298, 2024 ? Poulsen et al, J Urol, 160, 2024, 2024 ? Leissner et al, Br J Urol, 85, 817, 2024 第十五頁，共八十七頁。 Pelvic Iliac Lymphadenectomy Level of the inferior mesenteric artery 第二十二頁，共八十七頁。 USC/Norris Lymph Node Positive Bladder Cancer Experience Adjuvant Therapies Chemotherapy ? 139 patients (56%) ? Postop 126 (52%) ? Preop 7 (3%) ? Pre Postop 6 (2%) Radiation Therapy ? 37 patients (15%) ? Preop 26 (11%) ? Postop 8 (3%) ? Pre Postop 3 (1%) 第三十頁，共八十七頁。 USC/ NORRIS BLADDER CANCER EXPERIENCE (6/7112/97) 第三十八頁，共八十七頁。 Prognostic Factors in LN(+) Bladder Ca Univariate Analysis RecurrenceFree Survival Prognostic Factors RR pValue Age (65 yrs vs. ≤65 yrs) Gender (Female vs. Male) Urinary Diversion (Continent vs. Conduit) Lymph Nodes Removed (≥15 vs. 15) 第四十六頁，共八十七頁。 Extended Lymphadenectomy: Multicenter Prospective Trial Leissner et al., J. Urol., 171: 139, 2024. ? 290 cystectomies with extended LND ? Mapping study ? 81 (28%) LN + dz ? Median 43 LN removed ? Common site of mets: ? Obturators40% ? Levels: ? Ibelow mon iliacs ? IIaortic bifurcation below ? III IMA to aortic bifurcation 第五十四頁，共八十七頁。 第六十二頁，共八十七頁。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor 第七十頁，共八十七頁。 第七十八頁，共八十七頁。 Treatment of High Grade Invasive Bladder Cancer Radical Cystectomy ? Extended BPLND ? Pathologic staging ? 25% node + disease ? 33% longterm survival ? Highrisk group Rick Factors LN+ ? P Stage ? lymph nodes involved (tumor burden) ? lymph nodes removed (extent BPLND) 第八十六頁，共八十七頁。 。 (6/7112/97)。 PelvicIliac Lymphadectomy 第八十頁，共八十七頁。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor ? High grade tumor with cis ? cis unresponsive to intravesical therapy 第七十二頁，共八十七頁。 USC BLADDER CANCER EXPERIENCE RADICAL CYSTECTOMY Conclusions ? Improved morbidity and mortality ? Urinary reconstructive options available and improving ? Equally effective therapies have not emerged 第六十四頁，共八十七頁。 SURGICAL FACTORS IN BLADDER CANCER Herr H., BJU, 92: 187, 2024. ? Factors evaluated in the neoadjuvant MVAC trial* ? 270 randomized patients: ? 24 no LND ? 98 limited LND ? 146 standard LND ? Median of LN removed: 10 LNs ? Survival: ? 44% if 10 LN removed ? 61% if 10 LN removed *Grossman et al, N Eng J Med, 349: 859, 2024. 第五十六頁，共八十七頁。 Radical Cystectomy for High Grade Invasive Bladder Cancer Lymphadenectomy Allows for a safe anatomical dissection Provides pathologic stagi