本文报道一例膀胱高级别浸润性尿路上皮癌（MIBC）的患者。患者2年前诊断为膀胱癌伴多发淋巴结转移及阴茎转移，2022年6月22日行诊断性经尿道膀胱肿瘤电切术（TURBT）后予吉西他滨+顺铂（GC）联合替雷利珠单抗治疗6个疗程。2022年11月23日复查，提示膀胱多发病灶并累及肌层，继续予以免疫维持治疗，并盆腔放疗。2023年6月因甲减暂停免疫治疗，后恢复。2023年12月4日复查仍发现多发淋巴结转移。经广东省医学会泌尿外科疑难病例多学科会诊，建议予以患者维迪西妥单抗联合特瑞普利单抗 q2w治疗6周期。经治疗后，患者经尿道电切镜检+活检均未见癌灶，淋巴结较前明显缩小或消失。因此，对于孤立转移病灶的晚期尿路上皮癌，基于循证医学证据选择含免疫的一线治疗方案，联用放疗可进一步获益；一线治疗进展后，免疫“再挑战”仍旧可获益，免疫联合抗体偶联药物是可选方案。

This article reports a case with high-grade invasive urothelial carcinoma of the bladder. The patient was diagnosed as bladder cancer with multiple lymph node metastasis and penis metastasis two years ago. On June 22，2022，he was treated with Gemcitabine+Cisplatin （GC） combined with Lirilumab after diagnostic transurethral resection of bladder tumor（TURBT）. On November 23，2022，a follow-up examination revealed multiple lesions in the bladder involving the muscular layer. Immune maintenance therapy was continued，along with pelvic radiotherapy. In June 2023，immunotherapy was temporarily suspended due to hypothyroidism and later resumed. On December 4，2023，multiple lymph node metastases were still found during the follow-up examination. After a multidisciplinary consultation on difficult cases in Guangdong Urological Association，it is recommended that the patient be treated with Disitamab Vedotin combined with Toripalimab q2w for 6 cycles. After treatment，the patient's transurethral resection and biopsy did not show any cancer lesions，and the lymph nodes were significantly reduced or disappeared compared to before.Therefore，for advanced urothelial carcinoma with isolated metastatic lesions，based on evidence-based medicine，selecting first-line treatment options that include immunotherapy in combination with radiotherapy can further benefit.After the progress of first-line treatment，the immune "re-challenge" can still benefit，and the combination of immune and antibody conjugated drugs is an optional solution.