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.

Antineoplastic Combined Chemotherapy Protocols/*therapeutic use Chemotherapy Adjuvant/methods Cisplatin/therapeutic use Clinical Decision-Making/methods *Cystectomy Disease-Free Survival Female Humans Male Neoadjuvant Therapy/methods Neoplasm Recurrence Local/*epidemiology/pathology/prevention & control Neoplasm Staging Patient Selection *Sex Factors Urinary Bladder/pathology/surgery Urinary Bladder Neoplasms/mortality/pathology/*therapy Adjuvant chemotherapy Bladder cancer Gender Meta-analysis Neoadjuvant chemotherapy

Clinical Decision-Making Cystectomy/*methods Cytoreduction Surgical Procedures/methods Humans *Neoplasm Metastasis/pathology/therapy Practice Guidelines as Topic Treatment Outcome *Urinary Bladder Neoplasms/pathology/surgery Bladder cancer Lymph node dissection Lymph node metastasis Metastasectomy Metastatic bladder cancer Surgery interest including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg employment/affiliation grants or funding consultancies honoraria stock ownership or options expert testimony royalties or patents filed received or pending) are the following: None.

Age Factors Aged Aged 80 and over Clinical Decision-Making *Cystectomy/adverse effects/mortality Disease-Free Survival Female Geriatric Assessment Humans Life Expectancy Male Middle Aged Neoplasm Invasiveness Odds Ratio Patient Selection Quality of Life Radiotherapy/adverse effects/mortality Risk Factors Time Factors Treatment Outcome Urinary Bladder Neoplasms/mortality/pathology/*therapy Complications Elderly Mibc Outcome