Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Dec;29(12):1462-1469.
doi: 10.1111/iju.15014. Epub 2022 Aug 22.

Improved survival in real-world patients with advanced urothelial carcinoma: A multicenter propensity score-matched cohort study comparing a period before the introduction of pembrolizumab (2003-2011) and a more recent period (2016-2020)

Satoru Taguchi  1   2   3 , Taketo Kawai  1   4   5 , Tohru Nakagawa  4 , Jimpei Miyakawa  1 , Kenjiro Kishitani  1 , Kazuma Sugimoto  2 , Yu Nakamura  2 , Jun Kamei  6 , Daisuke Obinata  7 , Kenya Yamaguchi  7 , Tomoyuki Kaneko  4 , Kanae Yoshida  8 , Sachi Yamamoto  8 , Shigenori Kakutani  8 , Koichiro Kanazawa  9 , Yuriko Sugihara  9 , Mayuko Tokunaga  9 , Akihiko Matsumoto  10 , Yukari Uemura  11 , Yoshiyuki Akiyama  1 , Yuta Yamada  1 , Yusuke Sato  1 , Daisuke Yamada  1 , Yutaka Enomoto  8 , Hiroaki Nishimatsu  9 , Akira Ishikawa  3 , Yoshinori Tanaka  5 , Yasushi Nagase  10 , Tetsuya Fujimura  6 , Hiroshi Fukuhara  2 , Satoru Takahashi  7 , Haruki Kume  1
Affiliations
Multicenter Study

Improved survival in real-world patients with advanced urothelial carcinoma: A multicenter propensity score-matched cohort study comparing a period before the introduction of pembrolizumab (2003-2011) and a more recent period (2016-2020)

Satoru Taguchi et al. Int J Urol. 2022 Dec.

Abstract

Objectives: Although the treatment strategy for advanced urothelial carcinoma (aUC) has drastically changed since pembrolizumab was introduced in 2017, studies revealing current survival rates in aUC are lacking. This study aimed to assess (1) the improvement in survival among real-world patients with aUC after the introduction of pembrolizumab and (2) the direct survival-prolonging effect of pembrolizumab.

Methods: This multicenter retrospective study included 531 patients with aUC undergoing salvage chemotherapy, including 200 patients treated in the pre-pembrolizumab era (2003-2011; earlier era) and 331 patients treated in a recent 5-year period (2016-2020; recent era). Using propensity score matching (PSM), cancer-specific survival (CSS) and overall survival (OS) were compared between the earlier and recent eras, in addition to between the recent era, both with and without pembrolizumab use, and the earlier era.

Results: After PSM, the recent era cohort had significantly longer CSS (21 months) and OS (19 months) than the earlier era cohort (CSS and OS: 12 months). In secondary analyses using PSM, patients treated with pembrolizumab had significantly longer CSS (25 months) and OS (24 months) than those in the earlier era cohort (CSS and OS: 11 months), whereas patients who did not receive pembrolizumab in the recent era had similar outcomes (CSS and OS: 14 months) as the earlier era cohort (CSS and OS: 12 months).

Conclusions: Patients with aUC treated in the recent era exhibited significantly longer survival than those treated before the introduction of pembrolizumab. The improved survival was primarily attributable to the use of pembrolizumab.

Keywords: advanced; bladder cancer; metastatic; pembrolizumab; propensity score matching; urothelial carcinoma.

PubMed Disclaimer

Conflict of interest statement

None declared

Figures

FIGURE 1
FIGURE 1
Schema of the study design. In 531 patients with aUC undergoing salvage chemotherapy were included; of these patients, 331 were treated in the recent era (2016–2020), and 200 were treated in the period before pembrolizumab became available (2003–2011; earlier era). In the primary analysis (Aim 1), survival outcomes were compared between the recent era and earlier era cohorts using PSM. In the secondary analysis (Aim 2), which assessed the direct survival‐prolonging effect of pembrolizumab, survival outcomes were similarly compared between patients in the recent era cohort who received pembrolizumab and patients in the earlier era cohort using PSM. As a reference for the secondary analysis (Aim 2), survival was also compared between patients in the recent era cohort who did not receive pembrolizumab and patients in the earlier era cohort after PSM. aUC, advanced urothelial carcinoma; PSM, propensity score matching.
FIGURE 2
FIGURE 2
Kaplan–Meier curves after PSM depicting (a) CSS and (b) OS according to the era (2016–2020 vs. 2003–2011) in the primary analysis (Aim 1). CSS, cancer‐specific survival; MST, median survival time; OS, overall survival; PSM, propensity score matching.
FIGURE 3
FIGURE 3
Kaplan–Meier curves after PSM depicting (a) CSS and (b) OS according to the era and overall pembrolizumab use (2016–2020 with pembrolizumab use vs. 2003–2011) in the secondary analysis (Aim 2). CSS, cancer‐specific survival; MST, median survival time; OS, overall survival; PSM, propensity score matching.
FIGURE 4
FIGURE 4
Kaplan–Meier curves after PSM depicting (a) CSS and (b) OS according to the era and overall pembrolizumab use (2016–2020 without pembrolizumab use vs. 2003–2011) in the reference analysis (Aim 2). CSS, cancer‐specific survival; MST, median survival time; OS, overall survival; PSM, propensity score matching.
See this image and copyright information in PMC

References

    1. Bajorin DF, Dodd PM, Mazumdar M, Fazzari M, McCaffrey JA, Scher HI, et al. Long‐term survival in metastatic transitional‐cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol. 1999;17:3173–81. - PubMed
    1. von der Maase H, Hansen SW, Roberts JT, Dogliotti L, Oliver T, Moore MJ, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. 2000;18:3068–77. - PubMed
    1. von der Maase H, Sengelov L, Roberts JT, Ricci S, Dogliotti L, Oliver T, et al. Long‐term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol. 2005;23:4602–8. - PubMed
    1. Jessen C, Agerbaek M, Von Der Maase H. Predictive factors for response and prognostic factors for long‐term survival in consecutive, single institution patients with locally advanced and/or metastatic transitional cell carcinoma following cisplatin‐based chemotherapy. Acta Oncol. 2009;48:411–7. - PubMed
    1. Taguchi S, Nakagawa T, Hattori M, Niimi A, Nagata M, Kawai T, et al. Prognostic factors for metastatic urothelial carcinoma undergoing cisplatin‐based salvage chemotherapy. Jpn J Clin Oncol. 2013;43:923–8. - PubMed

Publication types