{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T21:51:12Z","timestamp":1778622672960,"version":"3.51.4"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Maintenance avelumab therapy after first\u2010line induction chemotherapy is a viable option in the evolving treatment paradigm for metastatic urothelial carcinoma (mUC); however, the clinical determinants of its efficacy remain unknown. Here, we explored the prognostic factors of maintenance avelumab therapy for mUC using a multicenter real\u2010world database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The review of the multicenter database identified 59 patients with mUC who did not progress during first\u2010line chemotherapy and subsequently received maintenance avelumab therapy. Progression\u2010free survival (PFS) and overall survival (OS) after the initiation of avelumab were analyzed, and prognostic factors were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age was 70\u2009years, and the primary lesion was the bladder in 28 (47.5%) patients. In the first\u2010line chemotherapy, gemcitabine plus cisplatin was administered in 40 (67.8%) patients. The number of chemotherapy cycles was 2\u20133\/4\/5\/6 in 7 (11.9%)\/22 (37.3%)\/6 (10.2%)\/24 (40.7%) patients. With a median follow\u2010up period of 13.2\u2009months, 38 (64.4%) patients progressed and 20 (33.9%) died. The median PFS and OS were 6.1\u2009months and not reached, respectively. Multivariable analysis demonstrated that hypoalbuminemia was the only independent predictor of poor PFS (hazard ratio, 2.70;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). Patients with hypoalbuminemia showed significantly shorter median PFS (3.3 vs. 12.0\u2009months;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) and OS (9.3\u2009months vs. not reached;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared to those with normal albumin.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypoalbuminemia was an independent prognostic factor in patients with mUC who were treated with maintenance avelumab therapy. Efforts to preserve nutritional status and avoid hypoalbuminemia may help optimize its efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70459","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:02:35Z","timestamp":1775883755000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic Significance of Hypoalbuminemia in Maintenance Avelumab Therapy After First\u2010Line Chemotherapy for Metastatic Urothelial Carcinoma: A Multicenter Real\u2010World Study (\n                    <scp>YUSHIMA<\/scp>\n                    Study)"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3256-2237","authenticated-orcid":false,"given":"Rie","family":"Muta","sequence":"first","affiliation":[{"name":"Department of Urology Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Department of Urology Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-2901","authenticated-orcid":false,"given":"Hajime","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Urology Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noboru","family":"Numao","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology Cancer Institute Hospital, Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Urology Saitama Cancer Center  Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Yoshinaga","sequence":"additional","affiliation":[{"name":"Department of Urology Soka Municipal Hospital  Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoko","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Department of Urology JA Toride Medical Center  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ichiro","family":"Yonese","sequence":"additional","affiliation":[{"name":"Department of Urology Saitama Red Cross Hospital  Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keita","family":"Izumi","sequence":"additional","affiliation":[{"name":"Department of Urology Dokkyo Medical University Saitama Medical Center  Saitama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takanobu","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Metropolitan Tama\u2010Nambu Chiiki Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sho","family":"Uehara","sequence":"additional","affiliation":[{"name":"Department of Urology Showa General Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kotaro","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Urology Tsuchiura Kyodo General Hospital  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Toide","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1949-1754","authenticated-orcid":false,"given":"Ryoji","family":"Takazawa","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Metropolitan Ohtsuka Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saori","family":"Araki","sequence":"additional","affiliation":[{"name":"Department of Urology Kohnodai Hospital  Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2757-8083","authenticated-orcid":false,"given":"Soichiro","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Urology Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhisa","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Urology Institute of Science Tokyo  Tokyo 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