Comparative Outcomes of Adjuvant Chemotherapy and Immunotherapy After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Multicenter Retrospective Study

Purpose: Adjuvant chemotherapy (AC) improves survival after radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC), and adjuvant immunotherapy with nivolumab has shown beneficial effects. However, direct comparisons between these treatments in clinical practice are limited. This study evaluated the real-world outcomes of patients who received no adjuvant therapy, AC, or adjuvant immunotherapy after RC. Methods: This multicenter, retrospective study included 528 patients who underwent RC at Osaka University and its affiliated hospitals between 2010 and 2024. The patients were categorized into 3 groups: no adjuvant therapy, AC, and adjuvant immunotherapy. Propensity score matching (PSM) was used to minimize selection bias. Kaplan–Meier and Cox regression analyses were used to evaluate disease-free and cancer-specific survival. Results: Median disease-free survival (DFS) was 16.6, 22.3, and 26.4 months in the no-adjuvant therapy, AC, and adjuvant immunotherapy groups, respectively. Both adjuvant treatments significantly improved disease-free and cancer-specific survival in lymph node-positive patients. Multivariate analysis confirmed that AC ( P < .001) and immunotherapy ( P = .030) were independent prognostic factors for DFS. After PSM, adjuvant immunotherapy showed significantly improved disease-free ( P = .002) and cancer-specific survival ( P = .004) compared with no adjuvant therapy. No significant differences in survival outcomes were observed between AC and adjuvant immunotherapy groups. Conclusion: Adjuvant immunotherapy is an effective alternative to chemotherapy after RC, particularly in lymph node-positive patients. These findings support the use of immunotherapy as a postoperative treatment strategy for MIBC. Further research is needed to refine the optimal adjuvant treatment approaches.