Metastatic Urothelial Carcinoma with Glandular Differentiation That Confirmed the Response by Autopsy Specimen to Second-Line mFOLFOX6 (Fluorouracil, Oxaliplatin, and Leucovorin) plus Bevacizumab Chemotherapy.
Metastatic Urothelial Carcinoma with Glandular Differentiation That Confirmed the Response by Autopsy Specimen to Second-Line mFOLFOX6 (Fluorouracil, Oxaliplatin, and Leucovorin) plus Bevacizumab Chemotherapy.
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DOI：
10.1159/000484597
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发表时间：
2017-09
影响因子：
0.8
通讯作者：
Yasui T
中科院分区：
文献类型：
--
作者：
Naiki T;Etani T;Naiki-Ito A;Fujii K;Ando R;Iida K;Nagai T;Sugiyama Y;Nakagawa M;Kawai N;Yasui T
尿路上皮癌（UC）中腺体分化的预后意义存在争议，迄今为止还没有针对腺体成分转移的既定治疗策略。我们在此描述一例伴有腺分化的转移性 UC 病例，在使用 S-1 和顺铂 (CDDP) 以及 mFOLFOX6（氟尿嘧啶、奥沙利铂和亚叶酸）加贝伐单抗 (mFOLFOX6+Bev) 序贯化疗后尸检时腺癌成分的组织学消失。一名62岁的亚洲男性通过根治性膀胱切除术和回肠导管诊断为浸润性UC伴腺分化（T2N0M0），并进行了仔细的随访观察。根治性手术八年后，发生腹膜转移，使用结肠纤维的活检标本显示高级别腺癌，其免疫组织化学特征包括细胞角蛋白 7 (CK7) 阳性、细胞角蛋白 20 (CK20) 和尿斑蛋白阴性，这与根治性膀胱切除术标本相同。因此，他接受了S-1和CDDP组成的联合化疗；然而，2个周期后腹膜转移恶化。因此，二线mFOLFOX6+Bev化疗共5个疗程。尽管如此，患者还是死亡，尸检的最终诊断是浸润性纯UC向肺、骨和腹膜多发转移。有趣的是，没有发现腺癌的病理学发现，并且转移灶的免疫组织化学特征与先前来自膀胱和结肠的标本相同。这表明 S-1 和 CDDP 序贯化疗以及二线 mFOLFOX6+Bev 可能是腺分化转移性 UC 的可行选择。
The prognostic significance of glandular differentiation in urothelial carcinoma (UC) is controversial, and thus far there is no established treatment strategy against metastasis of glandular component. We describe here a case of metastatic UC with glandular differentiation that had histological disappearance of adenocarcinoma components at autopsy after sequential chemotherapy with S-1 and cisplatin (CDDP) and with mFOLFOX6 (fluorouracil, oxaliplatin, and leucovorin) plus bevacizumab (mFOLFOX6+Bev). A 62-year-old Asian male was diagnosed with invasive UC with glandular differentiation (T2N0M0) by radical cystectomy and ileal conduit, and careful follow-up observation was made. Eight years after radical operation, peritoneal metastases occurred, and a biopsy specimen using colon fiber revealed high-grade adenocarcinomas with an immunohistochemical profile that included positivity for cytokeratin 7 (CK7) and negativity for cytokeratin 20 (CK20) and uroplakin, which was identical to the radical cystectomy specimen. Thus, he received combination chemotherapy consisting of S-1 and CDDP; however, the peritoneal metastasis worsened after 2 cycles. Therefore, second-line mFOLFOX6+Bev chemotherapy was performed for a total of 5 courses. In spite of this, the patient died, and the final diagnosis by autopsy was multiple metastases of infiltrating pure UC to the lung, bone, and peritoneum. Interestingly, there were no pathological findings of adenocarcinoma, and the immunohistochemical profile of the metastatic lesions was identical to that of the previous specimens from the bladder and colon. This suggests that sequential chemotherapy of S-1 and CDDP and second-line mFOLFOX6+Bev might be a feasible option in metastatic UC with glandular differentiation.