Yang Rui, Chen Jun-Xing, Luo Shu-Hang, Chen Ting-Ting, Chen Ling-Wu, Huang Bin
Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China.
The Medical Department, 3D Medicines Inc., Shanghai 200120, China.
World J Clin Cases. 2023 Feb 16;11(5):1165-1174. doi: 10.12998/wjcc.v11.i5.1165.
Invasive urothelial carcinoma (UC) with squamous and glandular differentiation is a highly malignant and complicated pathological subtype, and the standard care is radical cystectomy (RC). However, urinary diversion after RC significantly reduces patient quality of life, thus bladder-sparing therapy has become a research hotspot in this field. Recently, five immune checkpoint inhibitors have been approved for systemic therapy of locally advanced or metastatic bladder cancer by the Food and Drug Administration, but the efficacy of immunotherapy combined with chemotherapy for invasive UC is still unknown, especially for pathological subtypes with squamous and glandular differentiation.
We report the case of a 60-year-old male who complained of repetitive painless gross hematuria and was diagnosed with muscle-invasive bladder cancer with squamous and glandular differentiation, defined as cT3N1M0 according to the American Joint Committee on Cancer, who had a strong desire to preserve the bladder. Immunohistochemical staining revealed that programmed cell death-ligand 1 (PD-L1) expression in the tumor was positive. Thus, a transurethral resection to maximize removal of the bladder tumor was performed under cystoscopy, and the patient subsequently received a combination of chemotherapy (cisplatin/gemcitabine) and immunotherapy (tislelizumab) treatment. No tumor recurrence in the bladder was observed following pathological and imaging examination after 2 cycles and 4 cycles of treatment, respectively. The patient achieved bladder preservation and has been tumor-free for more than two years.
This case shows that the combination of chemotherapy and immunotherapy might be an effective and safe treatment strategy for PD-L1 expression positive UC with divergent histologic differentiation.
伴有鳞状和腺性分化的浸润性尿路上皮癌（UC）是一种高度恶性且复杂的病理亚型，标准治疗方法是根治性膀胱切除术（RC）。然而，RC术后的尿流改道显著降低了患者的生活质量，因此保膀胱治疗已成为该领域的研究热点。最近，五种免疫检查点抑制剂已被美国食品药品监督管理局批准用于局部晚期或转移性膀胱癌的全身治疗，但免疫疗法联合化疗治疗浸润性UC的疗效仍不清楚，尤其是对于伴有鳞状和腺性分化的病理亚型。
我们报告了一例60岁男性患者，其主诉反复无痛性肉眼血尿，被诊断为伴有鳞状和腺性分化的肌层浸润性膀胱癌，根据美国癌症联合委员会的定义为cT3N1M0，该患者强烈希望保留膀胱。免疫组织化学染色显示肿瘤中程序性细胞死亡配体1（PD-L1）表达为阳性。因此，在膀胱镜检查下进行了经尿道切除术以最大程度切除膀胱肿瘤，随后患者接受了化疗（顺铂/吉西他滨）和免疫疗法（替雷利珠单抗）联合治疗。分别在2个周期和4个周期治疗后的病理和影像学检查中未观察到膀胱肿瘤复发。该患者实现了膀胱保留，并且无肿瘤状态已超过两年。
该病例表明，化疗和免疫疗法联合可能是治疗PD-L1表达阳性、伴有不同组织学分化的UC的一种有效且安全的治疗策略。
