The impact of the interval between ureterorenoscopic (URS) biopsy and radical nephroureterectomy (RNU) on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) has not been extensively studied. This study aims to address this gap by analyzing real-world data from a tertiary referral hospital in Taiwan.

This retrospective study included 412 patients with localized UTUC who underwent URS biopsy followed by RNU at Taipei Veterans General Hospital between 2004 and 2020. Patients were categorized into two groups based on the interval between URS and RNU: ≤2 weeks and >2 weeks. Oncologic outcomes—including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS)—were assessed. Data were analyzed using Fisher’s exact test, the Mann-Whitney U test, the Kaplan-Meier method, and the Cox regression model (CRM).

The median follow-up period was 47.5 months (interquartile range: 17–75 months). Among the patients, 79 were in the ≤2 weeks group and 333 in the >2 weeks group. Clinicopathological characteristics were similar between groups in terms of age, sex, smoking history, prior or synchronous bladder cancer, pathological T stage, lymph node positivity, tumor grade, multifocality, concomitant carcinoma in situ, variant histology, and lymphovascular invasion. Multivariate Cox regression analysis revealed that a URS-to-RNU interval of >2 weeks was independently associated with worse OS (hazard ratio = 1.673, 95% confidence interval = 1.045–2.679, p = 0.032). Additional poor prognostic factors for OS included age ≥70, multifocality, higher pathological T stage, lymph node positivity, and variant histology.

A delay of more than two weeks between URS biopsy and RNU was associated with poorer OS in localized UTUC. To improve survival outcomes, clinical decision-making should prioritize timely RNU following URS.