採用多模式治療一局部晚期T3膀胱癌病例達到完全緩解
唐慈翊1,2、闕光瞬1,2、陳怡璇1,2、阮雍順2、柯宏龍1,2、葉信志1,2
高雄市立大同醫院1泌尿科
高雄醫學大學附設醫院2泌尿科
Complete remission achieved in a case of locally advanced T3 bladder cancer with multimodal therapy
Tsz-Yi Tang1,2, Wen-jeng Chueh1,2, Yi-Hsuan Chen1,2, Yung-Shun Juan1,2, Hung-Lung Ke1,2,
Hsin-Chih Yeh1,2
1Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Case report 07741762
A 57-year-old man presented to the urology clinic with two weeks of intermittent gross hematuria with blood clots. He denied flank pain, fever, chills, nausea, vomiting, or diarrhea. He had a history of hypertension. Laboratory tests were within normal limits. Ultrasonography revealed a bladder tumor. Computed tomography of the pelvis showed a 4.8x3.6 cm tumor in the anterior wall of the urinary bladder with perivesical infiltration, clinical stage cT3 (Figure 1). We performed laser en bloc resection of the bladder tumor (LERBT). Pathology showed high-grade infiltrating urothelial carcinoma, pT2. After a thorough discussion, the patient insisted on receiving bladder-sparing therapy. Therefore, the patient received 5 cycles of neoadjuvant chemoimmunotherapy, including gemcitabine, cisplatin, and pembrolizumab. Subsequent computed tomography suspected residual tumor in the anterior bladder wall, and we performed laparoscopic partial cystectomy (Figure 2). Surprisingly, pathology showed reactive urothelium associated with granulation tissue and chronic inflammation, with no evidence of malignancy. Cystography was performed on postoperative day 7, and no leakage was found. The catheter was removed, and the patient was discharged on postoperative day 8. There were no complications or recurrence of bladder cancer 1 year after surgery.
Conclusion:
We report a case of cT3N0M0 muscle-invasive bladder cancer who received neoadjuvant chemoimmunotherapy and bladder-sparing surgery. No local recurrence or distant metastasis was found in the follow-up one year after operation. We suggest that conservative multimodality therapy may achieve satisfactory results in patients with locally advanced bladder cancer.