Yang R, Chen JX, Luo SH, Chen TT, Chen LW, Huang B. Bladder preservation in complicated invasive urothelial carcinoma following treatment with cisplatin/gemcitabine plus tislelizumab: A case report. World J Clin Cases 2023; 11(5): 1165-1174 [PMID: 36874416 DOI: 10.12998/wjcc.v11.i5.1165]
Corresponding Author of This Article
Bin Huang, MD, PhD, Doctor, Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou 510080, Guangdong Province, China. huangb48@mail.sysu.edu.cn
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rui Yang, Jun-Xing Chen, Shu-Hang Luo, Ling-Wu Chen, Bin Huang, Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
Ting-Ting Chen, The Medical Department, 3D Medicines Inc., Shanghai 200120, China
Author contributions: Huang B contributed to conceptualization; Chen JX and Chen LW conducted the investigation; Yang R prepared the original draft; Luo SH wrote and reviewed the manuscript; Yang R and Chen TT edited the manuscript; All authors have read the article and approved the submitted version.
Informed consent statement: Written informed consent was obtained from the patient for the publication of any potentially identifiable images or data included in this article.
Conflict-of-interest statement: Author Ting-Ting Chen was employed by the company 3D Medicines Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Huang, MD, PhD, Doctor, Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou 510080, Guangdong Province, China. huangb48@mail.sysu.edu.cn
Received: November 4, 2022 Peer-review started: November 4, 2022 First decision: December 13, 2022 Revised: December 25, 2022 Accepted: January 20, 2023 Article in press: January 20, 2023 Published online: February 16, 2023 Processing time: 101 Days and 20.5 Hours
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
Core Tip: Urothelial carcinoma (UC) with complicated differentiation is highly malignant, and radical cystectomy (RC) is the preferred treatment. Because of the complications related to RC, bladder-sparing therapy has become a research hotspot. We here report a patient who was diagnosed with muscle-invasive bladder cancer with squamous and glandular differentiation and positive programmed cell death-ligand 1 (PD-L1) expression. The patient received a combination of chemotherapy and immunotherapy and achieved bladder preservation and has maintained tumor-free for over two years. This case highlights that the combination treatment might be an effective and safe strategy for UC with divergent histologic differentiation and positive PD-L1 expression.
