To define the incidence and predictors of metachronous contralateral recurrence in upper tract urothelial carcinoma and develop a risk score for tailored surveillance.
We analyzed 3024 patients surgically treated with curative intent from a multi-institutional registry (ROBUUST 3. 0). A composite risk score assigned one point each for prior bladder cancer, tumor multifocality, and estimated glomerular filtration rate at discharge <60 mL/min/1.73m2. Patients were stratified into low- (0 points), intermediate- (1-2 points), and high-risk (3 points). Cumulative incidence was estimated using competing risks regression models, accounting for death and distant metastasis, and internally validated using a cause-specific proportional hazards model.
Twenty patients (0.7%) developed contralateral recurrence over a median 26.5 months. Recurrence was significantly associated with prior bladder cancer (80% versus 31.5%, p<0.001), tumor multifocality (55% versus 20%, p=0.001), and lower estimated glomerular filtration rate at discharge (39 mL/min/1.73m2 versus 48 mL/min/1.73m2, p=0.01). Three-year cumulative incidence rates were 0.7% (low-risk), 0.9% (intermediate-risk), and 10.5% (high-risk) (p<0.001). High-risk patients faced an estimated 17-fold increased hazard versus low-risk patients. The model demonstrated excellent discriminative accuracy (Concordance Index 0.81).
Contralateral recurrence is rare but heavily dependent on prior bladder cancer, multifocality, and impaired renal function. Our internally validated risk score accurately stratifies patients, facilitating surveillance de-escalation for low-risk individuals and intensive monitoring for high-risk patients.
Urology practice. 2026 Jun 22 [Epub ahead of print]
Francesco Ditonno, Alessandro Veccia, Giacomo Musso, Ithaar H Derweesh, Zhenjie Wu, Linhui Wang, Firas Abdollah, Alfonso Santangelo, Carlo Silvani, Alex Stephens, Giuseppe Simone, Gabriele Tuderti, Flavia Proietti, Randall Lee, Alexander Kutikov, Ottavio De Cobelli, Marco Tozzi, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Gabriele Bignante, Enrico Checcucci, Roberto Contieri, Gianluca Spena, Sisto Perdonà , Lin Lin, Vitaly Margulis, Philipp Korn, Nirmish Singla, Melinda Fu, Saum Ghodoussipour, Andrea Minervini, Andrea Mari, Luca Lambertini, Omri Falik Nativ, Mark L Gonzalgo, Daniel A Sidhom, Chandru P Sundaram, Alec Zhu, Reza Mehrazin, Takashi Matsumoto, Masaki Shiota, Takashi Yoshida, Hidefumi Kinoshita, Alireza Deghanmanshadi, Soroush Rais-Bahrami, Hooman Ebrahimi, Hooman Djaladat, Karim Daher, Riccardo Autorino, Riccardo Bertolo, Alessandro Antonelli
Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy., Department of Urology, Rush University, Chicago, IL, USA., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA., Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA., Division of Urology, European Institute of Oncology IRCCS, Milan, Italy., Department of Urology, ASST Santi Paolo E Carlo, Milan, Italy., Department of Surgery, Candiolo Cancer Institute, FPO- IRCCS, Candiolo, Turin, Italy., Department of Urology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Brady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA., Section of Urologic Oncology, Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Oncologic Minimally Invasive Urology and Andrology Unit, Careggi Hospital, University of Florence, Florence, Italy., Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Urology, Indiana University, Indianapolis, IN, USA., Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Kansai Medical University, Osaka, Japan., Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA., Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, California, USA., Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA.