Radical nephroureterectomy with bladder cuff excision remains the standard treatment for upper tract urothelial carcinoma (UTUC), though many high-risk UTUC patients face significant risks of recurrence and progression. While adjuvant therapies have shown benefits in trials, their use is often limited by patient factors. This study aimed to develop a prognostic scoring model to assess recurrence risk post-surgery and guide adjuvant therapy decisions.

A retrospective analysis was conducted on 700 UTUC patients who underwent radical nephroureterectomy between 2012 and 2021. Patients who received neoadjuvant or adjuvant chemotherapy were excluded. Clinical and pathological variables were analyzed, and a recurrence risk model was developed using Cox proportional hazards regression, Kaplan-Meier survival analysis, and bootstrapping for internal validation.

The JIKEI-YAYOI score, based on pT stage, pN stage, tumor grade, and lymphovascular invasion, ranged from 0 to 7, demonstrating excellent predictive ability with a C-index of 0.815. Patients were stratified into low, intermediate, and high-risk groups, with significant differences in recurrence-free survival. This score enables individualized recurrence risk estimation, aiding decisions around adjuvant therapy.

The JIKEI-YAYOI score is a reliable tool for predicting recurrence after radical surgery for UTUC. It enhances personalized treatment strategies, including potential adjuvant therapies, and future studies should consider incorporating biomarkers for improved accuracy.