Surgical Treatment of Platinum-Resistant Recurrent Urothelial Carcinoma: A Case Report and Review

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Patients with upper urinary tract urothelial carcinoma often develop aggressive recurrences even after radical surgery, with reported recurrence rates ranging from 6.2% to 33%. This article presents a review on the topic and a clinical case of surgical treatment of platinum-resistant recurrent urothelial carcinoma. A 52-year-old male patient underwent right laparoscopic nephroureterectomy with resection of the right ureteral orifice due to a 1.5 cm tumor of the lower third of the right ureter complicated by hydronephrosis. Histological examination revealed a non-invasive papillary urothelial carcinoma of the ureteral mucosa, G2, pTa, with negative resection margins. No malignant cells were detected in the removed lymph nodes. Seven months later, the patient was diagnosed with a large recurrent tumor in the right posterolateral pelvis with signs of invasion into the bladder wall and sigmoid colon, which was resistant to platinum-based chemotherapy and lacked PD-L expression. Repeat surgery was performed, including radical cystoprostatevesiculectomy with Bricker ileal conduit, obstructive anterior resection of the rectum, and sigmoidostomy. Histological analysis revealed recurrent urothelial carcinoma of the right ureter with invasion into the prostate, bladder, and large intestine. Tumor regression was minimal. Resection margins of the intestine and ureter were free of tumor. Given the extent of the recurrent tumor and lack of response to standard chemotherapy, the patient was prescribed immunotherapy with pembrolizumab, which resulted in no further disease progression. A rare clinical case of treatment of advanced platinum-resistant recurrent urothelial carcinoma with long-term remission following surgical intervention is presented. This case describes the aggressive course of non-invasive urothelial carcinoma despite high-grade tumor differentiation.

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作者简介

Sergei Petrov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: petrov-uro@yandex.ru
ORCID iD: 0000-0003-3460-3427

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg

Vladislav Yakovlev

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: bestv@bk.ru
ORCID iD: 0000-0003-0013-4693
SPIN 代码: 8904-1849

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Arsen Mkrtchyan

Academician I.P. Pavlov First St. Petersburg State Medical University

编辑信件的主要联系方式.
Email: mkrarsensem@mail.ru
ORCID iD: 0009-0004-4546-4172
SPIN 代码: 8958-7190
俄罗斯联邦, Saint Petersburg

Sergey Reva

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: sgreva79@mail.ru
ORCID iD: 0000-0001-5183-5153
SPIN 代码: 8021-1510

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

参考

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  2. Tanaka N, Kikuchi E, Kanao K, et al. Metastatic behavior of upper tract urothelial carcinoma after radical nephroureterectomy: association with primary tumor location. Ann Surg Oncol. 2014;21(3):1038–1045. doi: 10.1245/s10434-013-3349-z EDN: SBGMOF
  3. Deng S, Liu L, Wang Y, et al. Laparoscopic versus open nephroureterectomy for upper tract urothelial carcinoma: a systematic review and meta-analysis of propensity-score matched studies. Surg Innov. 2024;31(5):520–529. doi: 10.1177/15533506241273378 EDN: XSIADI
  4. Grossmann NC, Soria F, Juvet T, et al. Comparing oncological and perioperative outcomes of open versus laparoscopic versus robotic radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: a multicenter, multinational, propensity score-matched analysis. Cancers (Basel). 2023;15(5):1409. doi: 10.3390/cancers15051409 EDN: OAMVKO
  5. Masson-Lecomte A, Gontero P, Birtle A, et al. EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma. European Association of Urology; 2025. Available from: https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma
  6. von der Maase H, Hansen SW, Roberts JT, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. 2000;18(17):3068–3077. doi: 10.1200/JCO.2000
  7. Gladkov OA, Bulychkin PV, Volkova MI, et al. Bladder cancer. Malignant Tumours. 2023;13(3s2):620–639. (In Russ.) doi: 10.18027/2224-5057-2023-13-3s2-1-620-639 EDN: TQQUJB
  8. Balar AV, Castellano DE, Grivas P, et al. Efficacy and safety of pembrolizumab in metastatic urothelial carcinoma: results from KEYNOTE-045 and KEYNOTE-052 after up to 5 years of follow-up. Ann Oncol. 2023;34(3):289–299. doi: 10.1016/j.annonc.2022.11.012 EDN: UNKVLH
  9. Powles T, Csőszi T, Özgüroğlu M, et al. Pembrolizumab alone or combined with chemotherapy versus chemotherapy as first-line therapy for advanced urothelial carcinoma (KEYNOTE-361): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(7):931–945. doi: 10.1016/S1470-2045(21)00152-2 EDN: RSNUHP

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2. Fig. 1. Magnetic resonance imaging. Neoplasm of the right ureter (marked with an arrow): a — axial projection; b — frontal projection.

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3. Fig. 2. Magnetic resonance imaging. Local recurrence of urothelial carcinoma (marked with an arrow).

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