Work

Kidney Stone History and Survival Outcomes in Upper Tract Urothelial Carcinoma

Year: 2025

Type: article

Abstract: Importance: Upper tract urothelial carcinoma (UTUC) is aggressive, and whether a history of urinary tract stones influences survival after radical nephroureterectomy (RNU) is unclear. Objective: To determine the association between urinary stone history and oncological outcomes in patients with UTUC undergoing RNU. Design, Setting, and Participants: 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. Exposure: Documented history of urinary tract stones identified via medical records. Main Outcomes and Measures: 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. Results: 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). Conclusions and Relevance: 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.

Source: JAMA Network Open

DOI: 10.1001/jamanetworkopen.2025.41054