PMC9377517_01
Images of the case 1 patient throughout the treatment. (A) Before treatment, abdomen enhanced CT showed localized invasion of the right wall lump of the bladder into the surrounding adipose tissue, invasion of the anterior bladder wall, and interruption of the continuity of the muscle layer. (B) After two courses of neoadjuvant chemotherapy, abdomen enhanced CT revealed a significantly reduced lump in the right wall of the bladder. (C) After maximal TURBT combined with tislelizumab, no tumor was seen on abdomen enhanced CT. (D) On February 18, 2022, the last follow-up abdomen enhanced CT showed no tumor recurrence.
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F1
The patient's pelvic magnetic resonance imaging (MRI) and whole abdomen enhanced computed tomography (CT) on August 21 and 24, 2020 showed an irregular lump involving the right wall of the bladder with a maximum cross-sectional size of  59 x 30 mm, involving part of the anterior wall, with interrupted continuity of the muscular layer and localized invasion of the surrounding adipose tissue (Figure 1A). TERT, and TP53 in the patient (Table 1). The combined positive score of the PD-L1 in the patient's tumor tissue was 70 and the tumor proportion score was 60% by immunohistochemistry (Supplementary Figures S1, S2). In the third cycle of treatment, pelvic MRI and whole abdomen enhanced CT showed a slight local thickening of the right wall of the bladder, which was significantly smaller than before (Figure 1B). To evaluate the efficacy of postoperative immunotherapy, the patient underwent a whole abdomen enhanced CT (Figure 1C) and biopsies by cystoscopy in March 2021 that showed normalcy and no tumor in the bladder. Until the end of follow-up on February 18, 2022, the patient maintained 15 months of no MIBC recurrence and a functional normal bladder, with no specific discomfort throughout the treatment course (Figure 1D).
Images of the case 2 patient throughout the treatment. (A) Before treatment, pelvic MRI cross-sectional T2W showed a lump in the left posterior wall of the bladder and mild dilatation of the left ureter. (B) After the first maximal TURBT and four cycles of adjuvant chemotherapy plus tislelizumab, no tumor was seen on pelvic MRI cross-sectional T2W. (C) After the second maximal TURBT and gemcitabine intravesical therapy, no tumor was seen on pelvic MRI cross-sectional T2W. (D) On April 12, 2022, the last follow-up, no tumor was seen on pelvic MRI cross-sectional T2W.
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F2
This time, pelvic MRI and positron emission tomography/computed tomography revealed a large lump measuring  56 x 53 mm located in the left posterior wall of the bladder, with a mildly dilated left ureter (Figure 2A). To evaluate the efficacy of adjuvant therapy, in August 2021, the patient underwent preoperative three urine cytologic examinations, fluorescence in situ hybridization examination, pelvic MRI (Figure 2B), whole abdomen enhanced CT, and the second diagnostic maximal TURBT, all of which showed normal, and no bladder tumor recurrence was observed. TURBT (resection to the depth of the serosal layer), all of which showed no signs of recurrence (Figure 2C). Throughout treatment, the patient underwent positron emission tomography/CT examination and no distant metastases of the tumor were detected. Until the end of follow-up on April 12, 2022, the patient's pelvic MRI showed no significant abnormalities in the bladder (Figure 2D).
PMC9377517_02
Images of the case 2 patient throughout the treatment. (A) Before treatment, pelvic MRI cross-sectional T2W showed a lump in the left posterior wall of the bladder and mild dilatation of the left ureter. (B) After the first maximal TURBT and four cycles of adjuvant chemotherapy plus tislelizumab, no tumor was seen on pelvic MRI cross-sectional T2W. (C) After the second maximal TURBT and gemcitabine intravesical therapy, no tumor was seen on pelvic MRI cross-sectional T2W. (D) On April 12, 2022, the last follow-up, no tumor was seen on pelvic MRI cross-sectional T2W.
fmed-09-949567-g0002.jpg
PMC9377517_02_fmed-09-949567-g0002.jpg
F2
This time, pelvic MRI and positron emission tomography/computed tomography revealed a large lump measuring  56 x 53 mm located in the left posterior wall of the bladder, with a mildly dilated left ureter (Figure 2A). To evaluate the efficacy of adjuvant therapy, in August 2021, the patient underwent preoperative three urine cytologic examinations, fluorescence in situ hybridization examination, pelvic MRI (Figure 2B), whole abdomen enhanced CT, and the second diagnostic maximal TURBT, all of which showed normal, and no bladder tumor recurrence was observed. TURBT (resection to the depth of the serosal layer), all of which showed no signs of recurrence (Figure 2C). Throughout treatment, the patient underwent positron emission tomography/CT examination and no distant metastases of the tumor were detected. Until the end of follow-up on April 12, 2022, the patient's pelvic MRI showed no significant abnormalities in the bladder (Figure 2D).