Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1165
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
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 chemot
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.