Upper tract urothelial carcinoma (UTUC) is aggressive, and whether a history of urinary tract stones influences survival after radical nephroureterectomy (RNU) is unclear.
To determine the association between urinary stone history and oncological outcomes in patients with UTUC undergoing RNU.
This multicenter retrospective cohort study was part of the Taiwan UTUC Registry Study, a multicenter registry encompassing 21 tertiary and regional hospitals throughout Taiwan. Medical records from September 1, 1988, to December 31, 2023, were reviewed; follow-up continued through December 31, 2024, and data were analyzed from January 15 to March 30, 2025. Participants were adults with histologically confirmed UTUC who underwent RNU.
Documented history of urinary tract stones identified via medical records.
Primary outcomes were cancer-specific survival (CSS) and disease-free survival (DFS). Secondary outcomes were overall survival (OS) and bladder recurrence-free survival (BRFS). Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazards models adjusted with overlap weighting.
Of 5824 registry patients, 3414 patients (mean [SD] age, 68.2 [10.5] years; 1957 female [57.3%]) met inclusion criteria. Among these, 169 (4.9%) had a history of urinary stones. Median (IQR) follow-up was 53.86 (23.72-92.50) months. Patients with history of urinary stones, compared with those without, had higher rates of metastasis (25 patients [14.8%] vs 233 patients [7.2%]) and UTUC-specific death (47 patients [27.8%] vs 599 patients [18.5%]). After overlap weighting, stone history was independently associated with worse CSS (HR, 1.83; 95% CI, 1.35-2.47; P < .001) and DFS (HR, 1.69; 95% CI, 1.29-2.21; P < .001). Stone history was not significantly associated with OS (HR, 1.18; 95% CI, 0.94-1.48) or BRFS (HR, 1.09; 95% CI, 0.86-1.37).
In this cohort study of patients with UTUC who underwent radical nephroureterectomy, a history of urinary tract stones was associated with inferior CSS and DFS, suggesting that patients with UTUC and stone history may represent a higher-risk subgroup that could warrant intensified surveillance and consideration of tailored adjuvant therapy.
JAMA network open. 2025 Nov 03*** epublish ***
Bor-En Jong, Hsi-Chin Wu, Wen-Chi Chen, Wen-Jeng Wu, Ching-Chia Li, Yi-Hsin Lu, Chen-Han Wilfred Wu, Yao-Chou Tsai
Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan., Department of Urology, China Medical University Hospital, Taichung, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine and University Hospitals, Cleveland, Ohio.