Metachronous Contralateral Recurrence in Upper Tract Urothelial Carcinoma: A Multi-Institutional Competing-Risks
Francesco Ditonno1, Alessandro Veccia1, Giacomo Musso2
1Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy.
Urology Practice
|June 22, 2026
Summary
Metachronous contralateral recurrence in upper tract urothelial carcinoma is rare, but prior bladder cancer, multifocal tumors, and poor kidney function increase risk. A validated risk score helps tailor patient surveillance strategies.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Upper tract urothelial carcinoma (UTUC) recurrence requires careful monitoring.
- Predicting metachronous contralateral recurrence is crucial for effective surveillance.
- Risk stratification aids in personalized patient management after UTUC treatment.
Purpose of the Study:
- To determine the incidence and predictors of metachronous contralateral recurrence in UTUC.
- To develop a risk score for guiding surveillance strategies in UTUC patients.
Main Methods:
- Analysis of 3024 patients with UTUC treated surgically with curative intent from a multi-institutional registry (ROBUUST 3.0).
- Development of a composite risk score based on prior bladder cancer, tumor multifocality, and estimated glomerular filtration rate (eGFR) at discharge (<60 mL/min/1.73m²).
- Internal validation using competing risks regression and cause-specific proportional hazards models.
Main Results:
- Contralateral recurrence occurred in 0.7% of patients over a median of 26.5 months.
- Significant predictors included prior bladder cancer (80% vs. 31.5%), tumor multifocality (55% vs. 20%), and lower eGFR (39 vs. 48 mL/min/1.73m²).
- Three-year cumulative incidence rates were 0.7% (low-risk), 0.9% (intermediate-risk), and 10.5% (high-risk), with high-risk patients having a 17-fold increased hazard.
Conclusions:
- Contralateral recurrence in UTUC is infrequent but strongly associated with specific risk factors.
- The developed risk score effectively stratifies patients into low, intermediate, and high-risk groups.
- This risk score enables tailored surveillance, de-escalating for low-risk patients and intensifying monitoring for high-risk individuals.
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