{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T07:38:17Z","timestamp":1792913897777,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate temporal changes in treatment patterns and survival outcomes across therapeutic eras in patients with metastatic urothelial carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter real\u2010world cohort study included 727 patients with metastatic urothelial carcinoma who received first\u2010line systemic therapy between July 2003 and September 2024. Patients were categorized into three treatment eras according to the initiation date of first\u2010line systemic therapy: the chemotherapy era (Chemo era), pembrolizumab era (Pembro era), and avelumab era (Ave era). Overall survival was analyzed using the Kaplan\u2013Meier method and compared using the log\u2010rank test. Cox proportional hazards regression analyses identified independent prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median overall survival was 12.7, 19.7, and 21.8\u2009months 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\u2010to\u2010lymphocyte ratio, elevated C\u2010reactive 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\u2010, avelumab\u2010, and enfortumab vedotin\u2010containing treatment sequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real\u2010world 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\u2010world evidence of changing treatment practices and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70679","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:44:59Z","timestamp":1792601099000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in Treatment Patterns and Survival Outcomes Across Therapeutic Eras in Metastatic Urothelial Carcinoma: A Multicenter Real\u2010World Study"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5256-4973","authenticated-orcid":false,"given":"Sadafumi","family":"Tomioka","sequence":"first","affiliation":[{"name":"Department of Urology Gifu Prefectural Tajimi Hospital  Tajimi Japan"},{"name":"Department of Urology Nagoya University Graduate School of Medicine  Nagoya 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