To evaluate the prognostic value of tumor size in patients with low-risk upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU).
A retrospective multicenter European analysis was conducted on 3,987 patients treated for UTUC at 17 academic institutions. After applying the exclusion criteria, 328 low-risk UTUC patients (pTaN0M0, low grade, unifocal, without hydronephrosis) were included in the analysis. Patients were stratified by tumor size in the RNU specimen: <1 cm, 1-1.9 cm, and ≥2 cm. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using Kaplan-Meier analysis. Univariable Cox regression analysis was used to evaluate the association between tumor size and disease recurrence. Because other confounding factors intrinsic to the study design were excluded, no multivariable analysis was performed.
After a median follow-up of 4.2 [3.9; 4.5] years, 41 (12.5%) patients experienced disease recurrence. Kaplan-Meier analysis showed that tumors ≥2 cm were significantly associated with lower RFS compared to tumors of 1-1.9 cm and <1 cm (81 % vs. 95 % and 97 %, respectively; p < 0.05). CSS and OS did not differ significantly among groups (all p>0.05). Univariable Cox regression analysis confirmed that tumor size ≥2 cm was a significant predictor of disease recurrence with HR= 7.18; 95%CI= [2.94-17.5] ; p<0.001.
Tumor size ≥2 cm is associated with an increased disease recurrence in low-risk UTUC. These findings align with the European Association of Urology guidelines, supporting the inclusion of tumors up to 2 cm within the low-risk category.
The French journal of urology. 2026 Jul 08 [Epub ahead of print]
Eléonore Petit, Idir Ouzaid, Mathieu Roumiguié, Marco Moschini, Francesco Soria, Jakub Dobruch, David D'Andrea, Cedric Poyet, Romain Mathieu, Mario Alvarez-Maestro, Francesco Montorsi, Wojciech Krajewski, Kees Hendriksen, Luca Afferi, Agostino Mattei, Stefania Zamboni, Claudio Simeone, Atiqullah Azziz, Gregory Verhoest, Shahrokh F Shariat, Benjamin Pradère, Morgan Rouprêt, Evanguelos Xylinas, Pierre-Etienne Gabriel
Department of Urology, Bichat Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris Nord, University Paris Cité, Paris, France., Department of Urology, Clinique Pasteur, Toulouse, France., Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, University Hospital Zürich, Zürich, Switzerland., Department of Urology, Service d'urologie, Rennes University Hospital, Hôpital Pontchaillou, France., Servicio Urologia, Hospital Universitario La Paz, Madrid, Spain., Department of Minimally Invasive and Robotic Urology, Wrocław Medical Univeristy, Wrocław, Poland., Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy., Department of Urology, University Medical Center Rostock, Rostock, Germany., Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. Department of Urology, Weill Cornell Medical College, New York, NY, USA. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan. College of Medical Health Technologies, Al-Turath University, Syndicates (Al-Niqabat Street), Mansour, Baghdad, Baghdad, Iraq., UROSUD Urology Department, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France., Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié- Salpetrière, 75013 Paris, France., Department of Urology, Bichat Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris Nord, University Paris Cité, Paris, France. Electronic address: .