Many patients experience significant declines in kidney function following radical nephroureterectomy with bladder cuff excision, rendering them ineligible for cisplatin-based chemotherapy (CMT) postoperatively. Identifying appropriate candidates for neoadjuvant CMT may improve patient outcomes.

This retrospective study included UTUC patients who underwent radical nephroureterectomy with bladder cuff excision between 2013 and 2023. Recurrence was defined as any disease relapse except for urothelial carcinoma of bladder (UCB) and contralateral UTUC. Cox proportional hazards regression was used to evaluate the impact of preoperative variables on recurrence risk and predictive model was developed.

A total of 194 patients were included, with a 2-year recurrence rate was 27.8%. Univariable analysis identified several factors associated with the recurrence including hydronephrosis, sessile tumor architecture, clinical stage ≥ cT3, female gender, history of UCB, tumor location in the ureter, multifocal tumors and lymph node dissection. On multivariable analysis, independent predictors of recurrence were clinical stage ≥ cT3, hydronephrosis, sessile tumor architecture, history of UCB, and female gender. The predictive model incorporating these factors demonstrated good accuracy, with a concordance index (C-index) of 0.88 and a predictive scoring model was developed for the estimation of 2-year recurrence risk.

Using a single-center dataset, we developed a predictive model for disease recurrence following radical nephroureterectomy with bladder cuff excision. This model, demonstrating strong predictive accuracy, may aid in appropriate patient selection for neoadjuvant CMT and guide preoperative and postoperative management decisions.