[A Case of Bladder Urothelial Carcinoma with Hepatic Metastasis Achieving Histologically Complete Response by Multimodal Treatment Including Pembrolizumab].

A 70s man underwent transurethral resection of the bladder tumor(TURBT)at a previous hospital. The pathological diagnosis was urothelial carcinoma pT1. Nine months later, recurrence appeared in the bladder and he underwent repeated TURBT. The pathological diagnosis was also pT1 and he was administered 8 courses of intravesical BCG therapy. Fourteen months after the first operation, computed tomography scans showed new lesions in the liver. Therefore, he was referred to our hospital. Because biopsy from the hepatic lesion confirmed the diagnosis of metastatic urothelial carcinoma, he received 10 courses of gemcitabine plus cisplatin(GC)and radiofrequency ablation. However, daughter nodule and enlargement of the main tumor were revealed on MRI 33 months after the initial TURBT. After 5 courses of pembrolizumab that limited the potential for hepatic metastases, he had no evidence of other metastatic sites and underwent laparoscopic right hepatectomy. There was no viable carcinoma in the pathological specimens of the hepatic lesions. Six months after hepatectomy, the patient has a high quality of life without any recurrence.