Evidence map›Paper›PMID 39023778›Full record

SynthesisWorld journal of urology2024

Adjuvant immune checkpoint inhibitors for urothelial carcinoma: systematic review and Meta-analysis.

Rashid K Sayyid, Rui Bernardino, Julian Chavarriaga, Ravi Kumar, Harkanwal Randhawa, Marian S Wettstein, Jessica Grace Cockburn, Zachary Klaassen, Neil E Fleshner

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in World journal of urology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Treatment Patterns and Outcomes After Recurrence Following Adjuvant Nivolumab for Urothelial Carcinoma: An AGEHA Real-World Study.International journal of urology : official journal of the Japanese Urological Association · 2026
    Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Rashid K SayyidDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. rksayyid@gmail.com.ORCID http://orcid.org/0000-0002-2133-569X
Rui BernardinoDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Julian ChavarriagaDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Ravi KumarDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Harkanwal RandhawaDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Marian S WettsteinDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Jessica Grace CockburnDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Zachary KlaassenDepartment of Urology, Wellstar MCG Health, Augusta, GA, USA.
Neil E FleshnerDivision of Urologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo compare disease-free survival (DFS), overall survival (OS), and adverse events (AEs) among muscle-invasive urothelial carcinoma (MIUC) patients receiving adjuvant immune checkpoint inhibitors (ICIs) versus placebo/observation following radical surgery.

methodsThis was a systematic review/meta-analysis of all published phase 3 randomized controlled trials. MEDLINE, EMBASE, and Cochrane were searched from inception until April 4, 2024. Pooled hazard ratios (HR) and relative risks (RR), plus confidence intervals (CI), were generated using frequentist random-effects modeling.

resultsThree trials were identified: IMvigor010, CheckMate 274, and AMBASSADOR. In the overall cohort, adjuvant ICIs significantly improved DFS by 23% (HR = 0.77, 95% CI = 0.65-0.90). No DFS benefit was observed in patients with upper tract disease (HR = 1.19, 95% CI = 0.86-1.64). The highest magnitude of DFS benefit was observed among patients who had received prior neoadjuvant chemotherapy (HR = 0.69) and pathologic node-positive disease (HR = 0.75). A similar DFS benefit was observed irrespective of tumor PD-L1 status. Pooled OS demonstrated a 13% non-significant benefit (HR = 0.87, 95% CI = 0.75-1.01). Grade ≥ 3 immune-mediated AEs occurred in 8.6% and 2.1% of ICI and placebo/observation patients, respectively (RR = 4.35, 95% CI = 1.02-18.5). AEs leading to treatment discontinuation occurred in 14.3% and 0.9% of patients, respectively.

conclusionAdjuvant ICIs confer a DFS benefit following radical surgery for MIUC, particularly among node-positive patients and those who received prior neoadjuvant chemotherapy. The lack of benefit for upper tract disease suggests that alternate adjuvant approaches, including chemotherapy, should be considered for these patients. Tumor PD-L1 status is not a predictive biomarker, highlighting the need for biomarkers in this setting.

Indexed as

Carcinoma, Transitional CellImmune Checkpoint InhibitorsUrinary Bladder NeoplasmsChemotherapy, AdjuvantHumansRandomized Controlled Trials as TopicSurvival RateImmune Checkpoint InhibitorsAdjuvants, immunologicCarcinoma, transitional cellImmunotherapyMeta-analysis

Identifiers

PMID39023778

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.