【文章內(nèi)容簡介】 九頁，共八十七頁。,USC/ NORRIS BLADDER CANCER EXPERIENCE RecurrenceFree Survival of 244 Patients with LN+ Disease Stratified by Lymph Node Density (20%),(6/7112/97),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+ 20% (n=89),LN+ =20% (n=155),p=0.001,第四十頁，共八十七頁。,USC/ NORRIS BLADDER CANCER EXPERIENCE RecurrenceFree Survival of 244 Patients with LN+ Disease Stratified by Adjuvant Chemotherapy (Yes vs. No),(6/7112/97),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,No (n=105),Yes (n=139),p=0.036,第四十一頁，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) 1.16 0.37 Gender (Female vs. Male) 1.27 0.22 Urinary Diversion (Continent vs. Conduit) 0.76 0.12 Lymph Nodes Removed (≥15 vs. 15) 0.73 0.21,第四十二頁，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) 1.16 0.37 Gender (Female vs. Male) 1.27 0.22 Urinary Diversion (Continent vs. Conduit) 0.76 0.12 Lymph Nodes Removed (≥15 vs. 15) 0.73 0.21 Adjuvant Chemotherapy (Yes vs. No) 0.70 0.038,第四十三頁，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) 1.16 0.37 Gender (Female vs. Male) 1.27 0.22 Urinary Diversion (Continent vs. Conduit) 0.76 0.12 Lymph Nodes Removed (≥15 vs. 15) 0.73 0.21 Adjuvant Chemotherapy (Yes vs. No) 0.70 0.038 Pathologic Subgroup (EV vs. OC) 1.72 0.004,第四十四頁，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) 1.16 0.37 Gender (Female vs. Male) 1.27 0.22 Urinary Diversion (Continent vs. Conduit) 0.76 0.12 Lymph Nodes Removed (≥15 vs. 20% vs. ≤20%) 2.36 0.001,第四十五頁，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) 1.16 0.37 Gender (Female vs. Male) 1.27 0.22 Urinary Diversion (Continent vs. Conduit) 0.76 0.12 Lymph Nodes Removed (≥15 vs. 20% vs. ≤20%) 2.36 8 vs. ≤8) 2.66 0.001,第四十六頁，共八十七頁。,Prognostic Factors in LN(+) Bladder Ca Multivariable Analysis,RecurrenceFree Survival Prognostic Factors RR pValue Pathologic Subgroup 1.46 0.05 (EV vs. OC) Adjuvant Chemotherapy 0.63 0.008 (Yes vs. No) Lymph Node Density 1.65 0.02 (20% vs. ≤20%) Lymph Nodes Involved 1.91 0.008 (8 vs. ≤8),第四十七頁，共八十七頁。,Radical Cystectomy for High Grade Invasive Bladder Cancer Lymphadenectomy,1. Allows for a safe anatomical dissection 2. Provides pathologic staging 3. Therapeutic benefits 4. Absolute limits of dissection unknown ?,第四十八頁，共八十七頁。,Radical Cystectomy Extent of Lymphadenectomy in LN+ Herr et al., J Urol., 167: 1295, 2002.,64 patients with LN+ Radical Cyst + PLND If 11 LN’s removed: Better local control ( 9% vs. 30%) Improved survival (44% vs 20%),,,0,5,10,15,20,25,30,%, 11 LN,Removed, 11 LN,Removed,Local Recurrence Rate,第四十九頁，共八十七頁。,Radical Cystectomy Extent of Lymphadenectomy in LN+ Herr et al., J Urol., 167: 1295, 2002.,64 patients with LN+ Radical Cyst + PLND If 11 LN’s removed: Better local control ( 9% vs. 30%) Improved survival (44% vs 20%),第五十頁，共八十七頁。,Radical Cystectomy Extent of Lymphadenectomy in LN+ Herr et al., J Urol., 167: 1295, 2002.,64 patients with LN+ Radical Cyst + PLND If 11 LN’s remo