Antibodies Monoclonal Humanized/*therapeutic use *Carcinoma Transitional Cell/drug therapy Humans Prognosis Retrospective Studies *Urinary Bladder Neoplasms/drug therapy Metastatic urothelial carcinoma Pembrolizumab Prognostic factor Janssen and Pfizer. Takahiro Kimura is a paid consultant/advisor of Astellas Bayer Janssen and Sanofi. Shahrokh F. Shariat is a paid as follows: Honoraria: Astellas AstraZeneca Bayer BMS Cepheid Ferring Ipsen Janssen Lilly MSD Olympus Pfizer Pierre Fabre Richard Wolf Roche Sanochemia Sanofi Takeda Urogen. Consulting or Advisory Role: Astellas AstraZeneca Bayer BMS Cepheid Ferring Ipsen Janssen Lilly MSD Olympus Pfizer Pierre Fabre Richard Wolf Roche Sanochemia Sanofi Takeda Urogen. Speakers Bureau: Astellas Astra Zeneca Bayer BMS Cepheid Ferring Ipsen Janssen Lilly MSD Olympus Pfizer Pierre Fabre Richard Wolf Roche Sanochemia Sanofi Takeda Urogen Movember Foundation. The other authors declare no conflicts of interest associated with this manuscript.

Adult Aged Aged 80 and over Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use B7-H1 Antigen/antagonists & inhibitors Carcinoma/*drug therapy/immunology/mortality/pathology Clinical Decision-Making Female Humans Immune Checkpoint Inhibitors/adverse effects/*therapeutic use Male Middle Aged Patient Selection Progression-Free Survival Time Factors Urinary Bladder Neoplasms/*drug therapy/immunology/mortality/pathology Urothelium/*drug effects/immunology/pathology Immune-checkpoint inhibitor Meta-analysis Programmed death-ligand 1 Urothelial carcinoma interests/personal relationships which may be considered as potential competing interests: The authors certify that all conflicts of interest including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the article are listed as follows: Shahrokh Shariat owns or co-owns the following patents: methods to determine prognosis after therapy for prostate cancer. Granted 2002-09-06. Methods to determine prognosis after therapy for bladder cancer. Granted 2003-06-19. Prognostic methods for patients with prostatic disease. Granted 2004-08-05. Soluble Fas: urinary marker for the detection of bladder transitional cell carcinoma. Granted 2010-07-20. He has a consulting or advisory role for the following: Astellas Astra Zeneca Bayer BMS Cepheid Ferring Ipsen Jansen Lilly MSD Olympus Pfizer Pierre Fabre Roche Sanochemia Sanofi Takeda Urogen and Wolff. All remaining authors have declared no conflicts of interest.