Trends in the use and efficacy of adjuvant immunotherapy in muscle-invasive urothelial carcinoma

Trends in the use and efficacy of adjuvant immunotherapy in muscle-invasive urothelial carcinoma

Abstract 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 immunothe...

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Main Authors: Shingo Hatakeyama, Naoki Fujita, Mizuki Kobayashi, Shuya Kandori, Daiki Ikarashi, Hiroki Fukuhara, Takuma Sato, Shingo Myoen, Motohide Uemura, Takamitsu Inoue, Masaaki Oikawa, Yasuhiro Kaiho, Jun Miyazaki, Yoshiyuki Kojima, Hisanobu Adachi, Akihiro Ito, Norihiko Tsuchiya, Wataru Obara, Hiroyuki Nishiyama, Tomonori Habuchi, Chikara Ohyama
Format: Article
Language:English
Published: Nature Portfolio 2025-07-01
Series:Scientific Reports
Subjects:
Adjuvant immunotherapy
Cystectomy
Nephroureterectomy
Prognosis
Urothelial carcinoma
Online Access:https://doi.org/10.1038/s41598-025-11319-w
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Summary:Abstract 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.
ISSN:2045-2322

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