Stage-Specific Prognostic Impact of Tumor Location in Upper Tract Urothelial Carcinoma: A Propensity Score-Matched...

The prognostic relevance of tumor location in upper tract urothelial carcinoma (UTUC), particularly the difference between renal pelvic and ureteral tumors, remains controversial. This study aimed to clarify the impact of tumor location on stage-specific survival and recurrence patterns following radical nephroureterectomy (RNU), using a large multi-institutional cohort.

Patients diagnosed with UTUC who underwent RNU between 2003 and 2023 were retrospectively reviewed and categorized into the renal pelvic urothelial carcinoma (RPUC) group or the ureteral urothelial carcinoma (UUC) group. Propensity score matching was then applied to adjust for baseline clinicopathological factors between the RPUC and UUC groups. Cancer-specific survival (CSS), nonurothelial tract recurrence-free survival (NUTRFS), and recurrence patterns were compared, with subgroup analyses being conducted according to pathological T stage (pTa/Tis/T1, pT2, and pT3/4).

We retrospectively analyzed 1,367 patients with UTUC. After propensity score matching, 5-year CSS and NUTRFS tended to be lower in the UUC group than in the RPUC group (CSS: 72% vs. 79%, p = 0.069; RFS: 55% vs. 62%, p = 0.072). In pT2 disease, outcomes were significantly worse in the UUC group (5-year CSS: 68% vs. 90%, p = 0.024; NUTRFS: 49% vs. 68%, p = 0.021). The UUC group also had significantly higher local recurrence rates at both pT2 and pT3/T4. In contrast, the RPUC group tended to have more distant metastases at pT3/4.

Tumor location in UTUC may influence stage-specific outcomes. These differences in outcomes underscore the need for individualized stage-specific management.