The management of advanced (locally advanced or metastatic) urothelial
carcinoma has been revolutionized since
pembrolizumab was introduced in 2017. Several prognostic factors for advanced urothelial
carcinoma treated with
pembrolizumab have been reported, including conventional parameters such as performance status and visceral (especially liver)
metastasis,
laboratory markers such as the neutrophil-to-lymphocyte ratio,
sarcopenia, histological/genomic markers such as programmed cell death
ligand 1 immunohistochemistry and
tumor mutational burden, variant histology, immune-related adverse events, concomitant medications in relation to the gut microbiome, primary
tumor site (
bladder cancer versus upper tract urothelial
carcinoma) and history/combination of
radiotherapy. The survival time of advanced urothelial
carcinoma has been significantly prolonged (or 'doubled' from 1 to 2 years) after the advent of
pembrolizumab, which will be further improved with novel agents such as
avelumab and
enfortumab vedotin. This review summarizes the latest evidence on clinical outcomes and prognostic factors of advanced urothelial
carcinoma in the contemporary era of
immune checkpoint inhibitors.