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Purpose <p>This study aimed to analyze a large multi-institutional UTUC database to identify prognostic factors in patients with organ-confined and non-organ-confined disease, and to further stratify pT2 patients using a nomogram to identify high-risk subgroups who may benefit from adjuvant therapy.</p> Methods <p>The records of patients diagnosed with UCTC who underwent nephroureterectomy from 1988 to 2022 at 15 hospitals in Taiwan were retrospectively reviewed. The outcomes evaluated were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS) after nephroureterectomy.</p> Results <p>A total of 2635 patients were included: 1935 with organ-confined (pTis/pTa/pT1/pT2 stage) disease, and 700 with non-organ confined (pT3/pT4 stage) disease. Significant risk factors for poor survival in patients with organ-confined disease were age ≥ 70 years, ureter involvement, high pathological T stage (pT2), multiplicity, lymphovascular invasion, and eGFR ≤ 44&#xa0;ml/min/1.73 m<sup>2</sup>. In patients with non-organ-confined disease, risk factors included male sex, age ≥ 70 years, ureter involvement, high pathological T stage (pT4), multiplicity, eGFR ≤ 44&#xa0;ml/min/1.73 m<sup>2</sup>, tumor necrosis, variant UC cell type, and smoking. In patients with pT2 UTUC, those classified as high risk based on a nomogram-derived total score &gt; 115 had significantly worse OS (<i>P</i> &lt; 0.0001) and CSS (<i>P</i> = 0.025) compared to those with a score ≤ 115 (low risk).</p> Conclusions <p>Patients with high-risk pT2 UTUC had significantly worse survival outcomes compared to those with low-risk pT2 UTUC. These findings suggest that further refinement of clinical trial designs is needed to better identify high-risk pT2 UTUC patients who may benefit from more aggressive treatment strategies, such as adjuvant therapy, while minimizing unnecessary systemic therapy in low-risk pT2 UTUC patients. Future studies should validate these findings and help establish the true value of systemic therapy for this patient population.</p>

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Risk stratification of high-risk muscle invasive upper urinary tract urothelial carcinoma: multi-institutional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月4日

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  • Hao-Lun Luo,
  • Hung-Lung Ke,
  • Wei-Ming Li,
  • Yao-Chou Tsai,
  • Shu-Yu Wu,
  • Shih-Hsiu Lo,
  • Yi-Huei Chang,
  • Chi-Ping Huang,
  • Hung-Jen Wang

摘要

Purpose

This study aimed to analyze a large multi-institutional UTUC database to identify prognostic factors in patients with organ-confined and non-organ-confined disease, and to further stratify pT2 patients using a nomogram to identify high-risk subgroups who may benefit from adjuvant therapy.

Methods

The records of patients diagnosed with UCTC who underwent nephroureterectomy from 1988 to 2022 at 15 hospitals in Taiwan were retrospectively reviewed. The outcomes evaluated were overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS) after nephroureterectomy.

Results

A total of 2635 patients were included: 1935 with organ-confined (pTis/pTa/pT1/pT2 stage) disease, and 700 with non-organ confined (pT3/pT4 stage) disease. Significant risk factors for poor survival in patients with organ-confined disease were age ≥ 70 years, ureter involvement, high pathological T stage (pT2), multiplicity, lymphovascular invasion, and eGFR ≤ 44 ml/min/1.73 m2. In patients with non-organ-confined disease, risk factors included male sex, age ≥ 70 years, ureter involvement, high pathological T stage (pT4), multiplicity, eGFR ≤ 44 ml/min/1.73 m2, tumor necrosis, variant UC cell type, and smoking. In patients with pT2 UTUC, those classified as high risk based on a nomogram-derived total score > 115 had significantly worse OS (P < 0.0001) and CSS (P = 0.025) compared to those with a score ≤ 115 (low risk).

Conclusions

Patients with high-risk pT2 UTUC had significantly worse survival outcomes compared to those with low-risk pT2 UTUC. These findings suggest that further refinement of clinical trial designs is needed to better identify high-risk pT2 UTUC patients who may benefit from more aggressive treatment strategies, such as adjuvant therapy, while minimizing unnecessary systemic therapy in low-risk pT2 UTUC patients. Future studies should validate these findings and help establish the true value of systemic therapy for this patient population.