Trends in the use and efficacy of adjuvant immunotherapy in muscle-invasive urothelial carcinoma
We investigated trends in the use of perioperative therapy and the efficacy of adjuvant immunotherapy on the prognosis of patients with muscle-invasive urothelial carcinoma (MIUC). The usage and trends in neoadjuvant and adjuvant therapy were examined, and the efficacy of adjuvant immunotherapy was assessed using propensity score-adjusted Cox multivariate analysis. We investigated 1383 patients with muscle-invasive bladder cancer and 1124 patients with upper tract urothelial carcinoma; 1095 (43.7%) patients received neoadjuvant therapy and 366 (14.6%) patients received adjuvant therapy. Adjuvant therapy usage rate increased from 30.3% before 2022 to 61% after 2022 in patients with pathological high-risk cancer (pT3-4, ypT2-4, or pN+). The adjuvant immunotherapy usage rate increased from 2.8% before 2022 to 67.5% after 2022. Sixty-three (18.9%) of the 334 patients with pathological high-risk cancer who were treated with adjuvant therapy were treated with adjuvant immunotherapy. The propensity score-adjusted Cox multivariate analysis showed that adjuvant immunotherapy significantly improved disease-free survival (Hazard ratios (HR) 0.39, P < 0.005) and overall survival (HR 0.20, P < 0.005) compared with conventional adjuvant chemotherapy. In conclusion, the introduction of adjuvant immunotherapy led to the increased use of adjuvant therapy and improved prognoses in patients with MIUC in real-world practice.
Authors
- Naoki Fujita (ORCID: https://orcid.org/0000-0001-8284-9582)
- Shuya Kandori (ORCID: https://orcid.org/0000-0003-4621-8470)
- Shingo Hatakeyama (ORCID: https://orcid.org/0000-0002-0026-4079)
- Tomonori Habuchi (ORCID: https://orcid.org/0000-0003-0998-4432)
- Mizuki Kobayashi (ORCID: https://orcid.org/0000-0002-4135-6789)
- M. Oikawa (ORCID: https://orcid.org/0000-0001-6832-3242)
- Akihiro Ito (ORCID: https://orcid.org/0000-0001-7224-1100)
- Norihiko Tsuchiya (ORCID: https://orcid.org/0000-0003-4242-2618)
- Yasuhiro Kaiho (ORCID: https://orcid.org/0000-0003-3793-8214)
- Wataru Obara
- Hiroki Fukuhara (ORCID: https://orcid.org/0000-0002-6332-9845)
- Takamitsu Inoue (ORCID: https://orcid.org/0000-0002-1362-4344)
- Chikara Οhyama (ORCID: https://orcid.org/0000-0003-1550-8379)
- Daiki Ikarashi (ORCID: https://orcid.org/0000-0001-8088-2848)
- Shingo Myoen
- Yoshiyuki Kojima (ORCID: https://orcid.org/0000-0001-8000-0868)
- Motohide Uemura (ORCID: https://orcid.org/0000-0001-7263-7965)
- Hiroyuki Nishiyama (ORCID: https://orcid.org/0009-0002-6589-5776)
- Takuma Sato (ORCID: https://orcid.org/0000-0003-4161-4052)
- Hisanobu Adachi
- Jun Miyazaki (ORCID: https://orcid.org/0000-0002-3618-0432)
Institutions
- Yamagata University (JP)
- Fukushima Medical University (JP)
- University of Tsukuba (JP)
- Hirosaki University (JP)
- Iwate Medical University (JP)
- Tohoku University (JP)
- Akita University (JP)
- Miyagi Prefectural Hospital Organization (JP)
- International University of Health and Welfare (JP)
- Tohoku Medical and Pharmaceutical University (JP)
Publication Details
- Journal
- Scientific Reports
- Published
- 2025-07-12
- DOI
- https://doi.org/10.1038/s41598-025-11319-w
- Citations
- 2
- Primary Topic
- Bladder and Urothelial Cancer Treatments
- Type
- article
- Field-Weighted Citation Impact
- 4.01
Funders
- Japan Society for the Promotion of Science