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Therefore, a comparative evaluation of their efficacy and toxicity compared with chemotherapy is necessary.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We comprehensively searched PubMed, Web of Science, Embase, and Cochrane Library databases and performed a meta\u2010analysis of randomized controlled trials up to July 2021. We considered overall survival as the primary outcome, and progression\u2010free survival, objective response rate, and treatment\u2010related adverse events as secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 3584 patients from five studies were evaluated. Compared with first\u2010line chemotherapy, programmed cell death\u20101\/ligand 1 inhibitors were significantly associated with worse progression\u2010free survival (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and adverse objective response rates (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). However, the treatments were not significantly different in terms of overall survival (<jats:italic>p<\/jats:italic>\u2009=\u20090.33). Compared with second\u2010line chemotherapy, programmed cell death\u20101\/ligand 1 inhibitors significantly improved overall survival (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and there was no statistically significant difference in progression\u2010free survival (<jats:italic>p<\/jats:italic>\u2009=\u20090.89) or objective response rate (<jats:italic>p<\/jats:italic>\u2009=\u20090.34). Compared with chemotherapy, programmed cell death\u20101\/ligand 1 inhibitors were well tolerated (first\u2010line chemotherapy: <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; second\u2010line chemotherapy: <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The efficacy of programmed cell death\u20101\/ligand 1 inhibitors in patients with advanced urothelial carcinoma is not superior to that of first\u2010line platinum\u2010based chemotherapy but is better than second\u2010line chemotherapy; however, programmed cell death\u20101\/ligand 1 inhibitors are safer than first\u2010 and second\u2010line chemotherapy and have a broader prospect for use in combination therapy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cai2.75","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T09:25:10Z","timestamp":1684488310000},"page":"191-202","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["PD\u20101\/L1 inhibitors can improve but not replace chemotherapy for advanced urothelial carcinoma: A systematic review and network meta\u2010analysis"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8320-2879","authenticated-orcid":false,"given":"Longkun","family":"Mao","sequence":"first","affiliation":[{"name":"Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat\u2010Sen Memorial Hospital Sun Yat\u2010Sen (Zhongshan) University Guangzhou China"},{"name":"Department of Urology, Sun Yat\u2010sen Memorial Hospital Sun Yat\u2010sen (Zhongshan) University Guangzhou 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