Upper tract urothelial carcinoma (UTUC) is an aggressive malignancy with variable survival outcomes. This study aims to evaluate cancer-specific survival (CSS), disease-free survival (DFS), overall survival (OS), and bladder recurrence-free survival (BRFS) among UTUC patients, with a particular focus on gender differences and associated prognostic factors.

A retrospective analysis was conducted on a cohort of 1,337 patients (male: 565, female: 772) diagnosed with UTUC. Survival outcomes, including CSS, DFS, OS, and BRFS, were analyzed using Kaplan-Meier survival curves, and differences between genders were assessed with the log-rank test. Cox proportional hazards regression models were used to identify independent prognostic factors. Baseline characteristics and clinical covariates, including age, comorbidities, ECOG performance status, tumor size, pathological stage, and treatment methods, were incorporated into multivariate models.

Kaplan-Meier survival analysis showed no statistically significant difference in CSS (p = 0.14), DFS (p = 0.19), or OS (p = 0.18) between male and female patients. However, BRFS was significantly better in females compared to males (p < 0.0001). In multivariate Cox regression analysis, female gender was associated with a reduced risk of bladder recurrence (HR = 0.55, 95% CI: 0.45–0.69, p < 0.001). Other significant predictors of survival outcomes included ECOG performance status, tumor stage, presence of lymphovascular invasion (LVI), surgical margin status, and preoperative hydronephrosis. Patients with high-grade tumors, multiple tumor locations, and advanced pathological stages demonstrated worse survival outcomes. Additionally, chemotherapy for UTUC was associated with poorer OS (HR = 1.64, p < 0.001) and CSS (HR = 3.70, p < 0.001), suggesting that these patients had more aggressive disease.

Gender differences in survival outcomes among UTUC patients were primarily observed in bladder recurrence-free survival, where females exhibited a lower risk of recurrence. No significant differences were found in CSS, DFS, or OS. Prognostic factors such as ECOG status, tumor stage, and surgical margin status played a crucial role in survival prediction. These findings underscore the importance of individualized risk assessment and tailored treatment strategies for UTUC patients.