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Perioperative Systemic Treatment Patterns and Postoperative Mortality Among Patients With Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy in Japan: WAKKA-MIBC Study.

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Title: Perioperative Systemic Treatment Patterns and Postoperative Mortality Among Patients With Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy in Japan: WAKKA-MIBC Study.
Authors: Kikuchi E; Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan., Tokumaru J; Medical Department, Astra Zeneca K.K., Tokyo, Japan., Kawai D; Medical Department, Astra Zeneca K.K., Tokyo, Japan., Ide R; Medical Department, Astra Zeneca K.K., Tokyo, Japan., Komazaki H; Medical Department, Astra Zeneca K.K., Tokyo, Japan., Kitagawa H; Medical Department, Astra Zeneca K.K., Tokyo, Japan., Inokuchi J; Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Source: International journal of urology : official journal of the Japanese Urological Association [Int J Urol] 2026 Jul; Vol. 33 (7), pp. e70565.
Publication Type: Journal Article; Observational Study
Language: English
Journal Info: Publisher: Blackwell Science Asia Country of Publication: Australia NLM ID: 9440237 Publication Model: Print Cited Medium: Internet ISSN: 1442-2042 (Electronic) Linking ISSN: 09198172 NLM ISO Abbreviation: Int J Urol Subsets: MEDLINE
Imprint Name(s): Publication: Carlton South, Vic. : Blackwell Science Asia
Original Publication: Tokyo ; New York : Churchill Livingstone, c1994-
MeSH Terms: Urinary Bladder Neoplasms*/mortality , Urinary Bladder Neoplasms*/pathology , Urinary Bladder Neoplasms*/therapy , Urinary Bladder Neoplasms*/surgery , Cystectomy*/methods , Neoadjuvant Therapy*/trends , Neoadjuvant Therapy*/statistics & numerical data , Neoadjuvant Therapy*/methods , Antineoplastic Combined Chemotherapy Protocols*/therapeutic use, Japan/epidemiology ; Chemotherapy, Adjuvant/trends ; Chemotherapy, Adjuvant/statistics & numerical data ; Deoxycytidine/analogs & derivatives ; Deoxycytidine/administration & dosage ; Cisplatin/administration & dosage ; Humans ; Female ; Retrospective Studies ; Male ; Aged ; Neoplasm Invasiveness ; Middle Aged ; Neoplasm Staging ; Gemcitabine
Abstract: Objectives: To characterize the temporal changes in perioperative systemic treatment patterns and postoperative mortality among Japanese patients with stage II-III muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC) from 2013 to 2024.
Methods: This retrospective observational cohort study assessed neoadjuvant chemotherapy (NAC) and adjuvant therapy (AT) relative to RC. Treatment patterns (NAC + RC + AT, NAC + RC, RC + AT, and RC alone), NAC regimen selection, and 30- and 90-day postoperative mortality were evaluated across three periods (2013-2017, 2018-2021, and 2022-2024). Analyses were descriptive.
Results: Among 5 208 patients, the use of NAC + RC increased from 31.4% in 2013-2017 to 50.4% in 2022-2024, and the use of NAC + RC + AT increased from 8.7% to 22.4%. RC alone decreased from 46.3% to 21.4%. Reduced-dose gemcitabine + cisplatin (GC) and gemcitabine + carboplatin were frequently used and remained common throughout the study period. In 2022-2024, 18.8% of patients received adjuvant nivolumab; most had received NAC beforehand (242/270). The 30- and 90-day mortality remained low regardless of the increase in NAC use (30-day: ≤ 0.2% with NAC vs. ≤ 1.5% without; 90-day: ≤ 1.4% with NAC vs. ≤ 3.3% without).
Conclusions: Perioperative systemic therapy for MIBC in Japan has intensified over the past decade, with increased adoption of NAC and adjuvant nivolumab. Dose-modified GC and carboplatin-based regimens have remained commonly used throughout the study period. Even with increased NAC use, postoperative mortality has remained low.
(© 2026 Astra Zeneca K.K. The Author(s). International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)
References: F. Bray, M. Laversanne, H. Sung, et al., “Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries,” CA: A Cancer Journal for Clinicians 74 (2024): 229–263.
I. Jubber, S. Ong, L. Bukavina, et al., “Epidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors,” European Urology 84 (2023): 176–190.
K. Grabe‐Heyne, C. Henne, P. Mariappan, G. Geiges, J. Pöhlmann, and R. F. Pollock, “Intermediate and High‐Risk Non‐Muscle‐Invasive Bladder Cancer: An Overview of Epidemiology, Burden, and Unmet Needs,” Frontiers in Oncology 13 (2023): 1170124.
J. P. Stein, G. Lieskovsky, R. Cote, et al., “Radical Cystectomy in the Treatment of Invasive Bladder Cancer: Long‐Term Results in 1,054 Patients,” Journal of Clinical Oncology 19 (2001): 666–675.
C. Pfister, G. Gravis, A. Fléchon, et al., “Dose‐Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin or Gemcitabine and Cisplatin as Perioperative Chemotherapy for Patients With Nonmetastatic Muscle‐Invasive Bladder Cancer: Results of the GETUG‐AFU V05 VESPER Trial,” Journal of Clinical Oncology 40 (2022): 2013–2022.
G. Anan, S. Hatakeyama, N. Fujita, et al., “Trends in Neoadjuvant Chemotherapy Use and Oncological Outcomes for Muscle‐Invasive Bladder Cancer in Japan: A Multicenter Study,” Oncotarget 8 (2017): 86130–86142.
T. Koie, C. Ohyama, H. Fujimoto, et al., “Diversity in Treatment Modalities of Stage II/III Urothelial Cancer in Japan: Sub‐Analysis of the Multi‐Institutional National Database of the Japanese Urological Association,” Japanese Journal of Clinical Oncology 46 (2016): 468–474.
A. Yamazawa, M. Tsuchiya, S. Imai, K. Ikegami, H. Kizaki, and S. Hori, “Survey of Perioperative Treatment in Muscle‐Invasive Bladder Cancer Using Japanese Hospital‐Based Claims Database,” BMC Urology 25 (2025): 309.
D. Canter, R. Viterbo, A. Kutikov, et al., “Baseline Renal Function Status Limits Patient Eligibility to Receive Perioperative Chemotherapy for Invasive Bladder Cancer and Is Minimally Affected by Radical Cystectomy,” Urology 77 (2011): 160–165.
D. F. Bajorin, J. A. Witjes, J. E. Gschwend, et al., “Adjuvant Nivolumab Versus Placebo in Muscle‐Invasive Urothelial Carcinoma,” New England Journal of Medicine 384 (2021): 2102–2114.
Ono Pharmaceutical Co., Ltd., “Nivolumab (Opdivo) Injection: Interview Form [in Japanese],” 2025, available from, https://www.info.pmda.go.jp/go/interview/1/180188_4291427A1024_1_047_1F.pdf.
N. J. Sathianathen, A. Kalapara, M. Frydenberg, et al., “Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta‐Analysis,” Journal of Urology 201 (2019): 715–720.
Medical Data Vision Co. Ltd., “Medical Data Vision [in Japanese/English],” available at, https://www.mdv.co.jp/about/advantage.html.
Japan Society for Pharmacoepidemiology, “Databases Available for Pharmacoepidemiology Researches in Japan (information obtained from survey answers as of August 2024),” available from, https://www.jspe.jp/wp‐content/uploads/2024/10/Table‐of‐DB‐survey‐results_240925.pdf.
L. H. Sobin, C. Wittekind, and Union for International Cancer Control, TNM Classification of Malignant Tumours, 6th ed. (John Wiley & Sons, Ltd, 2002).
L. H. Sobin, M. K. Gospodarowicz, and C. Wittekind, TNM Classification of Malignant Tumours, 7th ed. (John Wiley & Sons, Ltd, 2009).
J. D. Brierley, M. K. Gospodarowicz, and C. Wittekind, TNM Classification of Malignant Tumours, 8th ed. (John Wiley & Sons, Ltd, 2017).
S. Hatakeyama, R. Taoka, J. Miki, et al., “Effects of the Number of Neoadjuvant Cycles and Addition of Adjuvant Chemotherapy on the Prognosis of Muscle‐Invasive Bladder Cancer Treated With Radical Cystectomy,” Cancer Medicine 14 (2025): e70782.
H. Matsumoto, K. Shiraishi, H. Azuma, et al., “Clinical Practice Guidelines for Bladder Cancer 2019 Update by the Japanese Urological Association: Summary of the Revision,” International Journal of Urology 27 (2020): 702–709.
A. Richters, A. M. Leliveld, C. A. Goossens‐Laan, K. K. H. Aben, and B. C. Özdemir, “Sex Differences in Treatment Patterns for Non‐Advanced Muscle‐Invasive Bladder Cancer: A Descriptive Analysis of 3484 Patients of The Netherlands Cancer Registry,” World Journal of Urology 40 (2022): 2275–2281.
I. Nikulainen, A. P. Salminen, M. Högerman, H. Seikkula, P. J. Boström, and The Finnish National Cystectomy Database Research Group, “Neoadjuvant Chemotherapy in Muscle‐Invasive Bladder Cancer: A Nationwide Analysis of Eligibility, Utilization, and Outcomes,” Cancers (Basel) 17 (2025): 505.
P. Squires, K. Meng, X. Hu, et al., “Peri‐Operative Treatment Patterns in Real‐World Muscle‐Invasive Bladder Cancer Patients Undergoing Radical Cystectomy in the Era of Adjuvant Immunotherapy,” Journal of Clinical Oncology 43 (2025): 704.
“NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Bladder Cancer V.3.2025. © National Comprehensive Cancer Network, Inc.” (2025). All rights reserved.
T. Kawai, Y. Kurokawa, S. Taguchi, et al., “Optimization of Dose‐Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin Therapy for Japanese Patients With Urothelial Carcinoma,” Japanese Journal of Clinical Oncology 55 (2025): 421–427.
N. Hinata, A. A. Hussein, S. George, et al., “Impact of Suboptimal Neoadjuvant Chemotherapy on Peri‐Operative Outcomes and Survival After Robot‐Assisted Radical Cystectomy: A Multicentre Multinational Study,” BJU International 119 (2017): 605–611.
T. Powles, J. W. F. Catto, M. D. Galsky, et al., “Perioperative Durvalumab With Neoadjuvant Chemotherapy in Operable Bladder Cancer,” New England Journal of Medicine 391 (2024): 1773–1786.
C. Vulsteke, N. Adra, P. Danchaivijitr, et al., “Perioperative Enfortumab Vedotin and Pembrolizumab in Bladder Cancer,” New England Journal of Medicine 394 (2026): 1257–1269.
Bladder Cancer Clinical Practice Guideline Development Committee, “2022 Update to the Bladder Cancer Clinical Practice Guidelines 2019 edition [in Japanese],” September 2022, available from, https://www.urol.or.jp/lib/files/other/guideline/39_bladder_cancer_supplement.pdf.
N. Takada, T. Abe, N. Shinohara, et al., “Peri‐Operative Morbidity and Mortality Related to Radical Cystectomy: A Multi‐Institutional Retrospective Study in Japan,” BJU International 110 (2012): E756–E764.
C. V. Suartz, R. D. de Lima, L. S. de Almeida, et al., “Neoadjuvant Immunotherapy in Bladder Cancer: Ushering in a New Era of Treatment‐A Systematic Review of Current Evidence,” European Urology Open Science 79 (2025): 45–59.
Grant Information: AstraZeneca K.K.
Contributed Indexing: Keywords: cystectomy; database; neoadjuvant therapy; retrospective studies; urinary bladder neoplasms
Substance Nomenclature: 0W860991D6 (Deoxycytidine)
0 (Gemcitabine)
Q20Q21Q62J (Cisplatin)
Entry Date(s): Date Created: 20260725 Date Completed: 20260725 Latest Revision: 20260728
Update Code: 20260729
PubMed Central ID: PMC13401184
DOI: 10.1111/iju.70565
PMID: 42499313
Database: MEDLINE
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  Label: Title
  Group: Ti
  Data: Perioperative Systemic Treatment Patterns and Postoperative Mortality Among Patients With Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy in Japan: WAKKA-MIBC Study.
– Name: Author
  Label: Authors
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  Data: <searchLink fieldCode="AU" term="%22Kikuchi+E%22">Kikuchi E</searchLink>; Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.<br /><searchLink fieldCode="AU" term="%22Tokumaru+J%22">Tokumaru J</searchLink>; Medical Department, Astra Zeneca K.K., Tokyo, Japan.<br /><searchLink fieldCode="AU" term="%22Kawai+D%22">Kawai D</searchLink>; Medical Department, Astra Zeneca K.K., Tokyo, Japan.<br /><searchLink fieldCode="AU" term="%22Ide+R%22">Ide R</searchLink>; Medical Department, Astra Zeneca K.K., Tokyo, Japan.<br /><searchLink fieldCode="AU" term="%22Komazaki+H%22">Komazaki H</searchLink>; Medical Department, Astra Zeneca K.K., Tokyo, Japan.<br /><searchLink fieldCode="AU" term="%22Kitagawa+H%22">Kitagawa H</searchLink>; Medical Department, Astra Zeneca K.K., Tokyo, Japan.<br /><searchLink fieldCode="AU" term="%22Inokuchi+J%22">Inokuchi J</searchLink>; Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
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  Data: <searchLink fieldCode="JN" term="%229440237%22">International journal of urology : official journal of the Japanese Urological Association</searchLink> [Int J Urol] 2026 Jul; Vol. 33 (7), pp. e70565.
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  Data: Journal Article; Observational Study
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Blackwell+Science+Asia%22">Blackwell Science Asia </searchLink><i>Country of Publication: </i>Australia <i>NLM ID: </i>9440237 <i>Publication Model: </i>Print <i>Cited Medium: </i>Internet <i>ISSN: </i>1442-2042 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2209198172%22">09198172 </searchLink><i>NLM ISO Abbreviation: </i>Int J Urol <i>Subsets: </i>MEDLINE
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  Data: <i>Publication</i>: Carlton South, Vic. : Blackwell Science Asia<br /><i>Original Publication</i>: Tokyo ; New York : Churchill Livingstone, c1994-
– Name: SubjectMESH
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  Data: <searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms%22">Urinary Bladder Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms+mortality%22">mortality</searchLink> <br /><searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms%22">Urinary Bladder Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms+pathology%22">pathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms%22">Urinary Bladder Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms+therapy%22">therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms%22">Urinary Bladder Neoplasms*</searchLink>/<searchLink fieldCode="MM" term="%22Urinary+Bladder+Neoplasms+surgery%22">surgery</searchLink> <br /><searchLink fieldCode="MM" term="%22Cystectomy%22">Cystectomy*</searchLink>/<searchLink fieldCode="MM" term="%22Cystectomy+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Neoadjuvant+Therapy%22">Neoadjuvant Therapy*</searchLink>/<searchLink fieldCode="MM" term="%22Neoadjuvant+Therapy+trends%22">trends</searchLink> <br /><searchLink fieldCode="MM" term="%22Neoadjuvant+Therapy%22">Neoadjuvant Therapy*</searchLink>/<searchLink fieldCode="MM" term="%22Neoadjuvant+Therapy+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Neoadjuvant+Therapy%22">Neoadjuvant Therapy*</searchLink>/<searchLink fieldCode="MM" term="%22Neoadjuvant+Therapy+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Antineoplastic+Combined+Chemotherapy+Protocols%22">Antineoplastic Combined Chemotherapy Protocols*</searchLink>/<searchLink fieldCode="MM" term="%22Antineoplastic+Combined+Chemotherapy+Protocols+therapeutic+use%22">therapeutic use</searchLink><br /><searchLink fieldCode="MH" term="%22Japan%22">Japan</searchLink>/<searchLink fieldCode="MH" term="%22Japan+epidemiology%22">epidemiology</searchLink> ; <searchLink fieldCode="MH" term="%22Chemotherapy%2C+Adjuvant%22">Chemotherapy, Adjuvant</searchLink>/<searchLink fieldCode="MH" term="%22Chemotherapy%2C+Adjuvant+trends%22">trends</searchLink> ; <searchLink fieldCode="MH" term="%22Chemotherapy%2C+Adjuvant%22">Chemotherapy, Adjuvant</searchLink>/<searchLink fieldCode="MH" term="%22Chemotherapy%2C+Adjuvant+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> ; <searchLink fieldCode="MH" term="%22Deoxycytidine%22">Deoxycytidine</searchLink>/<searchLink fieldCode="MH" term="%22Deoxycytidine+analogs+%26+derivatives%22">analogs & derivatives</searchLink> ; <searchLink fieldCode="MH" term="%22Deoxycytidine%22">Deoxycytidine</searchLink>/<searchLink fieldCode="MH" term="%22Deoxycytidine+administration+%26+dosage%22">administration & dosage</searchLink> ; <searchLink fieldCode="MH" term="%22Cisplatin%22">Cisplatin</searchLink>/<searchLink fieldCode="MH" term="%22Cisplatin+administration+%26+dosage%22">administration & dosage</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Retrospective+Studies%22">Retrospective Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Neoplasm+Invasiveness%22">Neoplasm Invasiveness</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Neoplasm+Staging%22">Neoplasm Staging</searchLink> ; <searchLink fieldCode="MH" term="%22Gemcitabine%22">Gemcitabine</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: To characterize the temporal changes in perioperative systemic treatment patterns and postoperative mortality among Japanese patients with stage II-III muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC) from 2013 to 2024.<br />Methods: This retrospective observational cohort study assessed neoadjuvant chemotherapy (NAC) and adjuvant therapy (AT) relative to RC. Treatment patterns (NAC + RC + AT, NAC + RC, RC + AT, and RC alone), NAC regimen selection, and 30- and 90-day postoperative mortality were evaluated across three periods (2013-2017, 2018-2021, and 2022-2024). Analyses were descriptive.<br />Results: Among 5 208 patients, the use of NAC + RC increased from 31.4% in 2013-2017 to 50.4% in 2022-2024, and the use of NAC + RC + AT increased from 8.7% to 22.4%. RC alone decreased from 46.3% to 21.4%. Reduced-dose gemcitabine + cisplatin (GC) and gemcitabine + carboplatin were frequently used and remained common throughout the study period. In 2022-2024, 18.8% of patients received adjuvant nivolumab; most had received NAC beforehand (242/270). The 30- and 90-day mortality remained low regardless of the increase in NAC use (30-day: ≤ 0.2% with NAC vs. ≤ 1.5% without; 90-day: ≤ 1.4% with NAC vs. ≤ 3.3% without).<br />Conclusions: Perioperative systemic therapy for MIBC in Japan has intensified over the past decade, with increased adoption of NAC and adjuvant nivolumab. Dose-modified GC and carboplatin-based regimens have remained commonly used throughout the study period. Even with increased NAC use, postoperative mortality has remained low.<br /> (© 2026 Astra Zeneca K.K. The Author(s). International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)
– Name: Ref
  Label: References
  Group: RefInfo
  Data: F. Bray, M. Laversanne, H. Sung, et al., “Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries,” CA: A Cancer Journal for Clinicians 74 (2024): 229–263.<br />I. Jubber, S. Ong, L. Bukavina, et al., “Epidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors,” European Urology 84 (2023): 176–190.<br />K. Grabe‐Heyne, C. Henne, P. Mariappan, G. Geiges, J. Pöhlmann, and R. F. Pollock, “Intermediate and High‐Risk Non‐Muscle‐Invasive Bladder Cancer: An Overview of Epidemiology, Burden, and Unmet Needs,” Frontiers in Oncology 13 (2023): 1170124.<br />J. P. Stein, G. Lieskovsky, R. Cote, et al., “Radical Cystectomy in the Treatment of Invasive Bladder Cancer: Long‐Term Results in 1,054 Patients,” Journal of Clinical Oncology 19 (2001): 666–675.<br />C. Pfister, G. Gravis, A. Fléchon, et al., “Dose‐Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin or Gemcitabine and Cisplatin as Perioperative Chemotherapy for Patients With Nonmetastatic Muscle‐Invasive Bladder Cancer: Results of the GETUG‐AFU V05 VESPER Trial,” Journal of Clinical Oncology 40 (2022): 2013–2022.<br />G. Anan, S. Hatakeyama, N. Fujita, et al., “Trends in Neoadjuvant Chemotherapy Use and Oncological Outcomes for Muscle‐Invasive Bladder Cancer in Japan: A Multicenter Study,” Oncotarget 8 (2017): 86130–86142.<br />T. Koie, C. Ohyama, H. Fujimoto, et al., “Diversity in Treatment Modalities of Stage II/III Urothelial Cancer in Japan: Sub‐Analysis of the Multi‐Institutional National Database of the Japanese Urological Association,” Japanese Journal of Clinical Oncology 46 (2016): 468–474.<br />A. Yamazawa, M. Tsuchiya, S. Imai, K. Ikegami, H. Kizaki, and S. Hori, “Survey of Perioperative Treatment in Muscle‐Invasive Bladder Cancer Using Japanese Hospital‐Based Claims Database,” BMC Urology 25 (2025): 309.<br />D. Canter, R. Viterbo, A. Kutikov, et al., “Baseline Renal Function Status Limits Patient Eligibility to Receive Perioperative Chemotherapy for Invasive Bladder Cancer and Is Minimally Affected by Radical Cystectomy,” Urology 77 (2011): 160–165.<br />D. F. Bajorin, J. A. Witjes, J. E. Gschwend, et al., “Adjuvant Nivolumab Versus Placebo in Muscle‐Invasive Urothelial Carcinoma,” New England Journal of Medicine 384 (2021): 2102–2114.<br />Ono Pharmaceutical Co., Ltd., “Nivolumab (Opdivo) Injection: Interview Form [in Japanese],” 2025, available from, https://www.info.pmda.go.jp/go/interview/1/180188_4291427A1024_1_047_1F.pdf.<br />N. J. Sathianathen, A. Kalapara, M. Frydenberg, et al., “Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta‐Analysis,” Journal of Urology 201 (2019): 715–720.<br />Medical Data Vision Co. Ltd., “Medical Data Vision [in Japanese/English],” available at, https://www.mdv.co.jp/about/advantage.html.<br />Japan Society for Pharmacoepidemiology, “Databases Available for Pharmacoepidemiology Researches in Japan (information obtained from survey answers as of August 2024),” available from, https://www.jspe.jp/wp‐content/uploads/2024/10/Table‐of‐DB‐survey‐results_240925.pdf.<br />L. H. Sobin, C. Wittekind, and Union for International Cancer Control, TNM Classification of Malignant Tumours, 6th ed. (John Wiley & Sons, Ltd, 2002).<br />L. H. Sobin, M. K. Gospodarowicz, and C. Wittekind, TNM Classification of Malignant Tumours, 7th ed. (John Wiley & Sons, Ltd, 2009).<br />J. D. Brierley, M. K. Gospodarowicz, and C. Wittekind, TNM Classification of Malignant Tumours, 8th ed. (John Wiley & Sons, Ltd, 2017).<br />S. Hatakeyama, R. Taoka, J. Miki, et al., “Effects of the Number of Neoadjuvant Cycles and Addition of Adjuvant Chemotherapy on the Prognosis of Muscle‐Invasive Bladder Cancer Treated With Radical Cystectomy,” Cancer Medicine 14 (2025): e70782.<br />H. Matsumoto, K. Shiraishi, H. Azuma, et al., “Clinical Practice Guidelines for Bladder Cancer 2019 Update by the Japanese Urological Association: Summary of the Revision,” International Journal of Urology 27 (2020): 702–709.<br />A. Richters, A. M. Leliveld, C. A. Goossens‐Laan, K. K. H. Aben, and B. C. Özdemir, “Sex Differences in Treatment Patterns for Non‐Advanced Muscle‐Invasive Bladder Cancer: A Descriptive Analysis of 3484 Patients of The Netherlands Cancer Registry,” World Journal of Urology 40 (2022): 2275–2281.<br />I. Nikulainen, A. P. Salminen, M. Högerman, H. Seikkula, P. J. Boström, and The Finnish National Cystectomy Database Research Group, “Neoadjuvant Chemotherapy in Muscle‐Invasive Bladder Cancer: A Nationwide Analysis of Eligibility, Utilization, and Outcomes,” Cancers (Basel) 17 (2025): 505.<br />P. Squires, K. Meng, X. Hu, et al., “Peri‐Operative Treatment Patterns in Real‐World Muscle‐Invasive Bladder Cancer Patients Undergoing Radical Cystectomy in the Era of Adjuvant Immunotherapy,” Journal of Clinical Oncology 43 (2025): 704.<br />“NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Bladder Cancer V.3.2025. © National Comprehensive Cancer Network, Inc.” (2025). All rights reserved.<br />T. Kawai, Y. Kurokawa, S. Taguchi, et al., “Optimization of Dose‐Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin Therapy for Japanese Patients With Urothelial Carcinoma,” Japanese Journal of Clinical Oncology 55 (2025): 421–427.<br />N. Hinata, A. A. Hussein, S. George, et al., “Impact of Suboptimal Neoadjuvant Chemotherapy on Peri‐Operative Outcomes and Survival After Robot‐Assisted Radical Cystectomy: A Multicentre Multinational Study,” BJU International 119 (2017): 605–611.<br />T. Powles, J. W. F. Catto, M. D. Galsky, et al., “Perioperative Durvalumab With Neoadjuvant Chemotherapy in Operable Bladder Cancer,” New England Journal of Medicine 391 (2024): 1773–1786.<br />C. Vulsteke, N. Adra, P. Danchaivijitr, et al., “Perioperative Enfortumab Vedotin and Pembrolizumab in Bladder Cancer,” New England Journal of Medicine 394 (2026): 1257–1269.<br />Bladder Cancer Clinical Practice Guideline Development Committee, “2022 Update to the Bladder Cancer Clinical Practice Guidelines 2019 edition [in Japanese],” September 2022, available from, https://www.urol.or.jp/lib/files/other/guideline/39_bladder_cancer_supplement.pdf.<br />N. Takada, T. Abe, N. Shinohara, et al., “Peri‐Operative Morbidity and Mortality Related to Radical Cystectomy: A Multi‐Institutional Retrospective Study in Japan,” BJU International 110 (2012): E756–E764.<br />C. V. Suartz, R. D. de Lima, L. S. de Almeida, et al., “Neoadjuvant Immunotherapy in Bladder Cancer: Ushering in a New Era of Treatment‐A Systematic Review of Current Evidence,” European Urology Open Science 79 (2025): 45–59.
– Name: GrantInfo
  Label: Grant Information
  Group: Grant
  Data: AstraZeneca K.K.
– Name: SubjectMinor
  Label: Contributed Indexing
  Group:
  Data: <i>Keywords: </i>cystectomy; database; neoadjuvant therapy; retrospective studies; urinary bladder neoplasms
– Name: NumberCAS
  Label: Substance Nomenclature
  Group: ID
  Data: 0W860991D6 (Deoxycytidine)<br />0 (Gemcitabine)<br />Q20Q21Q62J (Cisplatin)
– Name: DateEntry
  Label: Entry Date(s)
  Group: Date
  Data: <i>Date Created: </i>20260725 <i>Date Completed: </i>20260725 <i>Latest Revision: </i>20260728
– Name: DateUpdate
  Label: Update Code
  Group: Date
  Data: 20260729
– Name: PubmedCentralID
  Label: PubMed Central ID
  Group: ID
  Data: PMC13401184
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/iju.70565
– Name: AN
  Label: PMID
  Group: ID
  Data: 42499313
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42499313
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/iju.70565
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: e70565
    Subjects:
      – SubjectFull: Japan epidemiology
        Type: general
      – SubjectFull: Chemotherapy, Adjuvant trends
        Type: general
      – SubjectFull: Chemotherapy, Adjuvant statistics & numerical data
        Type: general
      – SubjectFull: Deoxycytidine analogs & derivatives
        Type: general
      – SubjectFull: Deoxycytidine administration & dosage
        Type: general
      – SubjectFull: Cisplatin administration & dosage
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Retrospective Studies
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Aged
        Type: general
      – SubjectFull: Neoplasm Invasiveness
        Type: general
      – SubjectFull: Middle Aged
        Type: general
      – SubjectFull: Neoplasm Staging
        Type: general
      – SubjectFull: Gemcitabine
        Type: general
      – SubjectFull: Urinary Bladder Neoplasms mortality
        Type: general
      – SubjectFull: Urinary Bladder Neoplasms pathology
        Type: general
      – SubjectFull: Urinary Bladder Neoplasms therapy
        Type: general
      – SubjectFull: Urinary Bladder Neoplasms surgery
        Type: general
      – SubjectFull: Cystectomy methods
        Type: general
      – SubjectFull: Neoadjuvant Therapy trends
        Type: general
      – SubjectFull: Neoadjuvant Therapy statistics & numerical data
        Type: general
      – SubjectFull: Neoadjuvant Therapy methods
        Type: general
      – SubjectFull: Antineoplastic Combined Chemotherapy Protocols therapeutic use
        Type: general
    Titles:
      – TitleFull: Perioperative Systemic Treatment Patterns and Postoperative Mortality Among Patients With Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy in Japan: WAKKA-MIBC Study.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Kikuchi E
      – PersonEntity:
          Name:
            NameFull: Tokumaru J
      – PersonEntity:
          Name:
            NameFull: Kawai D
      – PersonEntity:
          Name:
            NameFull: Ide R
      – PersonEntity:
          Name:
            NameFull: Komazaki H
      – PersonEntity:
          Name:
            NameFull: Kitagawa H
      – PersonEntity:
          Name:
            NameFull: Inokuchi J
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 07
              Text: 2026 Jul
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1442-2042
          Numbering:
            – Type: volume
              Value: 33
            – Type: issue
              Value: 7
          Titles:
            – TitleFull: International journal of urology : official journal of the Japanese Urological Association
              Type: main
ResultId 1