Radical nephroureterectomy (RNU) is the gold standard treatment for non-metastatic upper tract urothelial carcinoma (UTUC). Adjuvant chemotherapy has been shown to improve oncological outcomes in stage II-IV cases. Cancer prognosis is influenced by multiple factors, with tumor stage being the most critical. This study evaluates the oncological outcomes of RNU in the treatment of UTUC.

This is a descriptive case series study, which includes patients diagnosed with UTUC who underwent radical nephroureterectomy at Cho Ray Hospital between January 2017 and December 2023. Kaplan-Meier survival analysis

From January 2017 to December 2023, 148 patients underwent radical nephroureterectomy for UTUC at Cho Ray Hospital, with 134 patients followed up. The male-to-female ratio was 1.7, and the mean age of the patients was 63.46 ± 11.13 years. All cases were classified as high-risk. Tumor stages I, II, III, and IV accounted for 20.9%, 32.5%, 27.7%, and 18.9% of cases, respectively. A total of 43 patients (29.1%) received full-dose adjuvant chemotherapy following surgery. The recurrence rate in the bladder was 14.9%, while the rate of contralateral recurrence was 2.2%. The overall survival rates at 1, 3, and 5 years were 76.3%, 44.8%, and 39.8%, respectively. The non-metastatic survival rates at 1, 3, and 5 years were 73.0%, 55.2%, and 43.9%, respectively. Tumor stage (T) and lymph node involvement (N) were significantly associated with both overall survival and non-metastatic survival (p<0.001). Adjuvant chemotherapy for pT2-4 tumors and/or nodal metastasis significantly improved both overall survival and non-metastatic survival (p<0.001).

Adjuvant chemotherapy for pT2-4 tumors and/or nodal metastasis significantly improves both overall and non-metastatic survival rates. Tumor stage (pT) and lymph node metastasis (pN) are crucial prognostic factors for survival.