上尿路尿路上皮癌伴多发脑转移1例

A Case of Upper Tract Urothelial Carcinoma with Multiple Brain Metastases

摘要: 目的：通过分享1例上尿路尿路上皮癌(UTUC)脑转移病例的治疗经验并回顾相关文献，提升对这类病症的认知，优化治疗方案。方法：介绍1例71岁男性左肾盂尿路上皮癌患者，其初诊时伴有腹膜后淋巴结及多处脑转移，组建多学科团队分析后，采用替雷利珠单抗联合维迪西妥单抗的治疗方案，进行随访观察。复习相关文献探讨该疾病特点及治疗现状。结果：治疗后患者左肾原发病灶达到完全缓解状态，脑转移灶部分缓解，神经系统症状显著改善，治疗一年后仍存活且生活质量良好。文献研究发现UTUC侵袭性强、预后差，脑转移治疗困难，免疫治疗和靶向治疗联合可能有潜在优势。结论：联合免疫疗法与抗体偶联药物(ADC)，或许能为尿路上皮癌脑转移患者带来理想的治疗效果，但仍需大样本前瞻性研究进一步验证疗效和明确作用机制。

Abstract: Objective: To enhance the understanding of this type of disease and optimize the treatment plan by sharing the treatment experience of a case of upper tract urothelial carcinoma (UTUC) with brain metastasis and reviewing relevant literature. Methods: A 71-year-old male patient with urothelial carcinoma of the left renal pelvis was introduced. At the initial diagnosis, he had retroperitoneal lymph node metastases and multiple brain metastases. After analysis by a multidisciplinary team, a treatment plan combining tislelizumab and vidicitumab was adopted, and follow-up observations were carried out. Relevant literature was reviewed to explore the characteristics of the disease and the current treatment status. Results: After treatment, the patient’s primary lesion in the left kidney achieved a complete remission, the brain metastases had a partial remission, and the neurological symptoms were significantly improved. One year after treatment, the patient was still alive and had a good quality of life. Literature research found that UTUC is highly invasive with a poor prognosis, and the treatment of brain metastases is difficult. The combination of immunotherapy and targeted therapy may have potential advantages. Conclusion: The combination of immunotherapy and antibody-drug conjugate (ADC) drugs may bring ideal treatment effects for patients with urothelial carcinoma and brain metastases. However, large-sample prospective studies are still needed to further verify the efficacy and clarify the mechanism of action.