Changes in Treatment Patterns and Survival Outcomes Across Therapeutic Eras in Metastatic Urothelial Carcinoma: A Multicenter Real-World Study.
10 affiliations
- 1Department of Urology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
- 2Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- 3Department of Urology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan.
- 4Department of Urology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
- 5Department of Urology, Toyohashi Municipal Hospital, Toyohashi, Japan.
- 6Department of Urology, Kariya Toyota General Hospital, Kariya, Japan.
- 7Department of Urology, Komaki City Hospital, Komaki, Japan.
- 8Department of Urology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
- 9Department of Urology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan.
- 10Department of Urology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan.
Abstract
Objectives
To evaluate temporal changes in treatment patterns and survival outcomes across therapeutic eras in patients with metastatic urothelial carcinoma.Methods
This retrospective multicenter real-world cohort study included 727 patients with metastatic urothelial carcinoma who received first-line systemic therapy between July 2003 and September 2024. Patients were categorized into three treatment eras according to the initiation date of first-line systemic therapy: the chemotherapy era (Chemo era), pembrolizumab era (Pembro era), and avelumab era (Ave era). Overall survival was analyzed using the Kaplan-Meier method and compared using the log-rank test. Cox proportional hazards regression analyses identified independent prognostic factors.Results
Median overall survival was 12.7, 19.7, and 21.8 months in the Chemo, Pembro, and Ave eras, respectively. Overall survival was significantly shorter in the Chemo era than in the other eras, whereas no significant difference was observed between the Pembro and Ave eras. In multivariable analysis, poor performance status, hypoalbuminemia, elevated neutrophil-to-lymphocyte ratio, elevated C-reactive protein level, and liver, lung, and bone metastasis were independently associated with poorer overall survival. The Pembro and Ave eras were independently associated with prolonged overall survival compared with the Chemo era. Treatment patterns changed over time, with decreasing use of chemotherapy alone and increasing use of pembrolizumab-, avelumab-, and enfortumab vedotin-containing treatment sequences.Conclusions
In this real-world cohort, survival outcomes improved across successive therapeutic eras in patients with metastatic urothelial carcinoma. Treatment patterns evolved with the introduction of novel systemic therapies, providing contemporary real-world evidence of changing treatment practices and outcomes.
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BibTeX
@article{tomioka2026changes,
title = {{Changes in Treatment Patterns and Survival Outcomes Across Therapeutic Eras in Metastatic Urothelial Carcinoma: A Multicenter Real-World Study.}},
author = {Sadafumi Tomioka and Satoshi Inoue and Rion Kawase and Yuriko Nagasaka and Tomoki Hattori and Noritoshi Shamoto and Fumihiro Ito and Yuri Yuguchi and Hideji Kawanishi and Motohiro Maeda and Kosuke Tochigi and Shusuke Akamatsu and Kenji Zennami and MEGUMI (MEidai GenitoUrinaryMega Investigation) project},
journal = {International journal of urology : official journal of the Japanese Urological Association},
year = {2026},
month = oct,
doi = {10.1111/iju.70679},
url = {https://europepmc.org/article/MED/42905533},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Changes in Treatment Patterns and Survival Outcomes Across Therapeutic Eras in Metastatic Urothelial Carcinoma: A Multicenter Real-World Study.
AU - Sadafumi Tomioka
AU - Satoshi Inoue
AU - Rion Kawase
AU - Yuriko Nagasaka
AU - Tomoki Hattori
AU - Noritoshi Shamoto
AU - Fumihiro Ito
AU - Yuri Yuguchi
AU - Hideji Kawanishi
AU - Motohiro Maeda
AU - Kosuke Tochigi
AU - Shusuke Akamatsu
AU - Kenji Zennami
AU - MEGUMI (MEidai GenitoUrinaryMega Investigation) project
PY - 2026
DA - 2026/10/01
JO - International journal of urology : official journal of the Japanese Urological Association
DO - 10.1111/iju.70679
UR - https://europepmc.org/article/MED/42905533
AB - Objectives To evaluate temporal changes in treatment patterns and survival outcomes across therapeutic eras in patients with metastatic urothelial carcinoma.Methods This retrospective multicenter real-world cohort study included 727 patients with metastatic urothelial carcinoma who received first-line systemic therapy between July 2003 and September 2024. Patients were categorized into three treatment eras according to the initiation date of first-line systemic therapy: the chemotherapy era (Chemo era), pembrolizumab era (Pembro era), and avelumab era (Ave era). Overall survival was analyzed using the Kaplan-Meier method and compared using the log-rank test. Cox proportional hazards regression analyses identified independent prognostic factors.Results Median overall survival was 12.7, 19.7, and 21.8 months in the Chemo, Pembro, and Ave eras, respectively. Overall survival was significantly shorter in the Chemo era than in the other eras, whereas no significant difference was observed between the Pembro and Ave eras. In multivariable analysis, poor performance status, hypoalbuminemia, elevated neutrophil-to-lymphocyte ratio, elevated C-reactive protein level, and liver, lung, and bone metastasis were independently associated with poorer overall survival. The Pembro and Ave eras were independently associated with prolonged overall survival compared with the Chemo era. Treatment patterns changed over time, with decreasing use of chemotherapy alone and increasing use of pembrolizumab-, avelumab-, and enfortumab vedotin-containing treatment sequences.Conclusions In this real-world cohort, survival outcomes improved across successive therapeutic eras in patients with metastatic urothelial carcinoma. Treatment patterns evolved with the introduction of novel systemic therapies, providing contemporary real-world evidence of changing treatment practices and outcomes.
SN - 0919-8172
SN - 1442-2042
ER -