【正文】 rognostic 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 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. 15) 0.73 0.21,第四十二頁，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 Pathologic Subgroups (OC vs. EV),(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,Extravesical (n=169),Organ Confined (n=75),p=0.003,第三十八頁，共八十七頁。,USC/ NORRIS BLADDER CANCER EXPERIENCE RecurrenceFree Survival of 244 Patients with LN+ Disease Stratified by Carcinoma in Situ (Present / Absent),(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,Absent (n=91),Present (n=153),p=0.73,第三十六頁，共八十七頁。,USC/Norris Lymph Node Positive Bladder Cancer Experience Outcomes Analysis,Presence of Cis Primary pathologic subgroup Total of lymph nodes removed Total of lymph nodes involved Lymph node density ( + LN/ LN removed),第三十四頁，共八十七頁。,USC/Norris Lymph Node Positive Bladder Cancer Experience Morbidity 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,第三十二頁，共八十七頁。 Postop 3 (1%),第三十頁，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 amp。,第二十八頁，共八十七頁。,Obturator fossa,Pelvic Iliac Lymphadenectomy,Presacral lymph nodes,第二十六頁，共八十七頁。,Pelvic Iliac Lymphadenectomy,第二十四頁，共八十七頁。,Pelvic Iliac Lymphadenectomy,第二十二頁，共八十七頁。,USC BLADDER CANCER EXPERIENCE PStage and Lymph Node +,第二十頁，共八十七頁。,USC/Norris Lymph Node Positive Bladder Cancer Experience Patients,Time period: July 1971 Dec 1997 Total lymph node +: 244 (24%) Gender: 191 males (78%)。,Lymph Node Positive Bladder Cancer Lymph Node Density,Novel concept of involved LN / of LN removed Accounts for: 1. LN tumor burden 2. Extent of PLND,第十七頁，共八十七頁。,Radical Cystectomy Extent of Lymphadenectomy,Prognostic factors in LN disease: Herr et al, J Urol, 167 1298, 2002 Poulsen et al, J Urol, 160, 2015, 2002 Leissner et al, Br J Urol, 85, 817, 2000,第十五頁，共八十七頁。,Radical Cystectomy Extent of Lymphadenectomy,Prognostic factors in LN disease: Herr et al, J Urol, 167 1298, 2002 Poulsen et al, J Urol, 160, 2015, 2002 Leissner et al, Br J Urol, 85, 817, 2000,第十三頁，共八十七頁。,USC Ra