Prognostic factors for mortality and recurrence after radical nephroureterectomy for UTUC: a Brazilian cohort study

Abstract

Abstract Purpose To evaluate the risk factors associated with mortality and recurrence following nephroureterectomy for upper tract urothelial carcinoma (UTUC) in a large Brazilian cohort. Methods This retrospective study analyzed 126 patients who underwent nephroureterectomy for UTUC between 2009 and 2023 at a single institution in Brazil. Cox regression and Kaplan–Meier analyses were performed to identify factors associated with mortality and recurrence. Results The median follow-up duration was 38 months. In multivariate analysis, positive surgical margins (HR 3.45, 95% CI 1.52–7.69, p=0.003), presence of carcinoma in situ (HR 2.63, 95% CI 1.27–5.56, p=0.009), and systemic recurrence (HR 3.33, 95% CI 1.32–9.09, p=0.01) were independently associated with increased mortality. The laparoscopic approach was not associated with worse outcomes than open surgery. Conclusion This large Brazilian cohort study identified several prognostic factors for mortality and recurrence after nephroureterectomy in patients with UTUC. Achieving negative surgical margins and identifying high-risk pathological features are critical for optimizing the outcomes. The laparoscopic approach was not associated with worse oncological outcomes in this cohort. These findings may help guide patient management and follow-up strategies.