Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis

Abstract Background There is still controversy regarding the safety and efficacy of atezolizumab for the treatment of urothelial carcinoma (UC). This research aimed to extensively investigate the effectiveness and safety of atezolizumab as a therapy for UC. Methods A thorough literature review was c...

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Main Authors: Jun Xie, Qiu-yu Mao, Jun-hao Chen, Hong-jin Shi, Pei-qin Zhan, Hai-feng Wang
Format: Article
Language:English
Published: BMC 2025-04-01
Series:World Journal of Surgical Oncology
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Online Access:https://doi.org/10.1186/s12957-025-03795-1
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author Jun Xie
Qiu-yu Mao
Jun-hao Chen
Hong-jin Shi
Pei-qin Zhan
Hai-feng Wang
author_facet Jun Xie
Qiu-yu Mao
Jun-hao Chen
Hong-jin Shi
Pei-qin Zhan
Hai-feng Wang
author_sort Jun Xie
collection DOAJ
description Abstract Background There is still controversy regarding the safety and efficacy of atezolizumab for the treatment of urothelial carcinoma (UC). This research aimed to extensively investigate the effectiveness and safety of atezolizumab as a therapy for UC. Methods A thorough literature review was conducted using databases including PubMed, Embase, the Cochrane Library, and Web of Science. The search included studies published from the inception of each database until May 24, 2024. The primary outcomes, progression-free survival (PFS) and overall survival (OS), were calculated using hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). Results Ten randomized controlled trials (RCTs) totaling 4,148 participants were included in our analysis. Compared to UC patients who received a placebo, either alone or in combination with chemotherapy medications, aggregated data showed that patients with UC who received atezolizumab had significantly longer OS(HR = 0.88, 95% CI [0.83, 0.94], p < 0.0001). Three RCTs also provided data on PFS, showing that patients who received atezolizumab, either in addition to or instead of chemotherapy, had significantly longer PFS than those who received placebo with or without chemotherapy (HR = 0.85, 95% CI [0.76, 0.95], p = 0.004). Conclusions Atezolizumab has demonstrated significant improvements in OS and PFS among patients with UC, offering crucial insights for decision-making in UC immunotherapy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails , identifier [CRD42024556757].
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spelling doaj-art-e3717723b2c1499f8803f410ee86bec22025-08-20T02:17:05ZengBMCWorld Journal of Surgical Oncology1477-78192025-04-0123111210.1186/s12957-025-03795-1Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysisJun Xie0Qiu-yu Mao1Jun-hao Chen2Hong-jin Shi3Pei-qin Zhan4Hai-feng Wang5Urology Department of the Second Affiliated Hospital of Kunming Medical UniversityUrology Department of the Second Affiliated Hospital of Kunming Medical UniversityUrology Department of the Second Affiliated Hospital of Kunming Medical UniversityUrology Department of the Second Affiliated Hospital of Kunming Medical UniversityUrology Department of the Second Affiliated Hospital of Kunming Medical UniversityUrology Department of the Second Affiliated Hospital of Kunming Medical UniversityAbstract Background There is still controversy regarding the safety and efficacy of atezolizumab for the treatment of urothelial carcinoma (UC). This research aimed to extensively investigate the effectiveness and safety of atezolizumab as a therapy for UC. Methods A thorough literature review was conducted using databases including PubMed, Embase, the Cochrane Library, and Web of Science. The search included studies published from the inception of each database until May 24, 2024. The primary outcomes, progression-free survival (PFS) and overall survival (OS), were calculated using hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). Results Ten randomized controlled trials (RCTs) totaling 4,148 participants were included in our analysis. Compared to UC patients who received a placebo, either alone or in combination with chemotherapy medications, aggregated data showed that patients with UC who received atezolizumab had significantly longer OS(HR = 0.88, 95% CI [0.83, 0.94], p < 0.0001). Three RCTs also provided data on PFS, showing that patients who received atezolizumab, either in addition to or instead of chemotherapy, had significantly longer PFS than those who received placebo with or without chemotherapy (HR = 0.85, 95% CI [0.76, 0.95], p = 0.004). Conclusions Atezolizumab has demonstrated significant improvements in OS and PFS among patients with UC, offering crucial insights for decision-making in UC immunotherapy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails , identifier [CRD42024556757].https://doi.org/10.1186/s12957-025-03795-1Urothelial carcinomaAtezolizumabImmune checkpoint inhibitorSurvival prognostic valueMeta-analysis
spellingShingle Jun Xie
Qiu-yu Mao
Jun-hao Chen
Hong-jin Shi
Pei-qin Zhan
Hai-feng Wang
Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis
World Journal of Surgical Oncology
Urothelial carcinoma
Atezolizumab
Immune checkpoint inhibitor
Survival prognostic value
Meta-analysis
title Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis
title_full Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis
title_fullStr Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis
title_full_unstemmed Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis
title_short Efficacy and safety of atezolizumab in the treatment of urothelial carcinoma: a systematic review and meta-analysis
title_sort efficacy and safety of atezolizumab in the treatment of urothelial carcinoma a systematic review and meta analysis
topic Urothelial carcinoma
Atezolizumab
Immune checkpoint inhibitor
Survival prognostic value
Meta-analysis
url https://doi.org/10.1186/s12957-025-03795-1
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