Risk Assessment of Non-Urinary Tract Recurrence After Radical Nephroureterectomy Based on CheckMate 274 Trial...

To assess the risk of non-urinary tract recurrence after radical nephroureterectomy for patients with upper urinary tract carcinoma according to CheckMate 274 trial eligibility.

We evaluated patients who underwent radical nephroureterectomy between 2012 and 2022 for upper urinary tract carcinoma. Recurrence was defined as extra-urinary tract recurrence. Univariate and multivariable analyses were used to determine the risk factors for recurrence according to CheckMate 274 trial eligibility.

Among 545 patients, 127 (23.3%) experienced recurrence during the follow-up period. Three-hundred sixty two (66.4%) patients were not eligible for CheckMate 274 trial criteria while 183 (33.6%) patients were eligible. The multivariable analysis demonstrated that preoperative renal dysfunction (HR2.24, 95% CI: 1.37-3.65, p = 0.001), presence of lymphovascular invasion (HR1.89, 95% CI: 1.18-3.00, p = 0.008)., positive resection margin (HR2.58, 95% CI: 1.43-4.66, p = 0.002), positive lymph node status (HR: 2.34, 95% CI: 1.21-4.55, p = 0.012) were risk factors for CheckMate 274 eligible patients. On the other hand, among 362 ineligible patients, performing preoperative diagnostic ureteroscopy (HR 3.09, 95% CI: 1.55-6.17, p = 0.001), presence of lymphovascular invasion (HR3.81, 95% CI: 1.78-8.17, p < 0.001), presence of histological subtype (HR4.82, 95% CI: 1.91-12.13, p < 0.001) and pathological T2 stage (HR2.28, 95% CI: 1.08-4.81, p = 0.031) were risk factors for recurrence.

According to our study, it may be possible to discuss the needs of adjuvant treatment in each individual. These findings provide a basis for more informed decisions regarding adjuvant therapy in UTUC, with the potential to reduce unnecessary treatment.