Abstract
Background: Adjuvant nivolumab prolongs disease-free survival (DFS) after radical surgery for high-risk urothelial carcinoma (UC), yet recurrence remains common. We investigated the prognostic impact of clinical and systemic inflammatory factors in these patients. Methods: We retrospectively analyzed 127 patients who received adjuvant nivolumab following radical surgery at six institutions between April 2022 and January 2026. Prognostic factors for DFS were evaluated using Cox proportional hazards regression models. Results: The median follow-up was 12.0 months, and DFS events occurred in 43.3% of patients. In the multivariable analysis, advanced pathological T stage (pT3–4 vs. pT1–2) (HR [hazard ratio], 2.525; 95% CI [confidence interval], 1.067–5.979) and baseline neutrophil-to-lymphocyte ratio (NLR) (HR, 1.216 per 1 unit increase; 95% CI, 1.034–1.430; p = 0.018) emerged as independent predictors of inferior DFS. Additionally, female sex showed an independent association with shorter DFS (HR, 0.275; 95% CI, 0.152–0.495; p < 0.001, though this finding warrants cautious interpretation given baseline characteristics and the small proportion of female patients. Conclusions: Baseline NLR and advanced pT stage serve as valuable independent prognostic factors for patients receiving adjuvant nivolumab. Although interpreted with caution regarding specific subgroups and retrospective limitations, these findings highlight key risk factors in this setting and provide a rationale for larger prospective validation.