{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:21:24Z","timestamp":1789993284933,"version":"4.0.1"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Immune checkpoint inhibitors and enfortumab vedotin have opened new avenues for sequential treatment strategies for locally advanced\/metastatic urothelial carcinoma (la\/mUC). In the pre\u2010enfortumab vedotin era, many patients could not receive third\u2010line treatment owing to rapid disease progression and poor general status. This study aimed to analyze real\u2010world sequential treatment practices for la\/mUC in Japan, with a focus on patients who do not receive third\u2010line treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data for 1023 la\/mUC patients diagnosed between January 2020 and December 2021 at 54 institutions from a Japanese nationwide cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At the median follow\u2010up of 28.5\u2009months, the median overall survival from first\u2010line initiation for 905 patients who received systemic anticancer treatment was 19.1\u2009months. Among them, 81% and 32% received second\u2010 and third\u2010line treatment. Notably, 52% had their treatment terminated before the opportunity for third\u2010line treatment. Multivariate logistic regression analysis revealed that low performance status (\u22651), elevated neutrophil\u2010to\u2010lymphocyte ratio (\u22653), and low body mass index (&lt;21\u2009kg\/m<jats:sup>2<\/jats:sup>) at the start of first\u2010line treatment were independent risk factors for not proceeding to third\u2010line treatment (<jats:italic>p<\/jats:italic>\u2009=\u20090.0024, 0.0069, and 0.0058, respectively). In this cohort, 33% had one of these factors, 36% had two, and 15% had all three.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study highlights the high frequency of factors associated with poor tolerance to anticancer treatment in la\/mUC patients. The findings suggest the need to establish optimal sequential treatment strategies, maximizing efficacy within time and tolerance constraints, while concurrently providing strong supportive care, considering immunological and nutritional aspects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iju.15411","type":"journal-article","created":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T07:06:03Z","timestamp":1706857563000},"page":"552-559","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Real\u2010world sequential treatment patterns and clinical outcomes among patients with advanced urothelial carcinoma in Japan"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6942-9695","authenticated-orcid":false,"given":"Yuki","family":"Kita","sequence":"first","affiliation":[{"name":"Department of Urology Kyoto University Graduate School of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikari","family":"Otsuka","sequence":"additional","affiliation":[{"name":"Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6322-9190","authenticated-orcid":false,"given":"Katsuhiro","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Urology Kyoto University Graduate School of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4524-2815","authenticated-orcid":false,"given":"Takuto","family":"Hara","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe University  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soichiro","family":"Shimura","sequence":"additional","affiliation":[{"name":"Department of Urology Kitasato University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6494-819X","authenticated-orcid":false,"given":"Takashi","family":"Kawahara","sequence":"additional","affiliation":[{"name":"Department of Urology University of Tsukuba  Tsukuba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Urology Osaka Metropolitan University  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sojun","family":"Kanamaru","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe City Nishi\u2010Kobe Medical Center  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Urology Kurashiki Central Hospital  Kurashiki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Urology Yokohama City University  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Igarashi","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe City Medical Center General Hospital  Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8902-7853","authenticated-orcid":false,"given":"Tomokazu","family":"Sazuka","sequence":"additional","affiliation":[{"name":"Department of Urology Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dai","family":"Takamatsu","sequence":"additional","affiliation":[{"name":"Department of Urology Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-4642","authenticated-orcid":false,"given":"Kohei","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Urology Sapporo Medical University  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-7632","authenticated-orcid":false,"given":"Takashige","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Urology Hokkaido University  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6104-4344","authenticated-orcid":false,"given":"Sei","family":"Naito","sequence":"additional","affiliation":[{"name":"Department of Urology Yamagata University  Tsuruoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of Urology National Cancer Center Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Nishiyama","sequence":"additional","affiliation":[{"name":"Department of Urology Yamagata University  Tsuruoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Department of Urology University of Toyama  Toyama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1069-2816","authenticated-orcid":false,"given":"Takashi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Urology Kyoto University Graduate School of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Japan Urological Oncology Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1613683"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2002788"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2035807"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3233\/BLC-170149"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2019.1591424"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2018-0654"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2019.03.013"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctarc.2021.100325"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/cas.14762"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.10.2638"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.14861"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdj079"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00262-021-03000-8"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.15101"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdr587"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0326"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.4599"}],"container-title":["International Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iju.15411","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T09:51:46Z","timestamp":1714816306000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iju.15411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1111\/iju.15411"],"URL":"https:\/\/doi.org\/10.1111\/iju.15411","archive":["Portico"],"relation":{},"ISSN":["0919-8172","1442-2042"],"issn-type":[{"value":"0919-8172","type":"print"},{"value":"1442-2042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]},"assertion":[{"value":"2023-11-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}