Prognostic value of histological subtypes in upper tract urothelial carcinoma treated with radical nephroureterectomy: Results from the ROBUUST database
Recommended Citation
Contieri R, Spena G, Izzo A, Derweesh IH, Wu Z, Singla N, Djaladat H, Lee R, Margulis V, Antonelli A, Simone G, Minervini A, Abdollah F, Yoshida T, Shiota M, Sundaram CP, Gonzalgo ML, Ferro M, Rais-Bahrami S, Porpiglia F, Mehrazin R, Ghodoussipour S, Perdonà S, Autorino R. Prognostic value of histological subtypes in upper tract urothelial carcinoma treated with radical nephroureterectomy: Results from the ROBUUST database. Eur Urol 2026; 89:2.
Document Type
Conference Proceeding
Publication Date
3-1-2026
Publication Title
Eur Urol
Keywords
Urology & Nephrology
Abstract
Introduction & Objectives: Histological subtypes (HS) are associated with aggressive disease and poor outcomes in urothelial bladder cancer. However, their prognostic impact in upper tract urothelial carcinoma (UTUC) remains less defined. We evaluated the prognostic impact of HS on oncological outcomes (metastasis and recurrence) in a large, international cohort of UTUC patients treated with radical nephroureterectomy (RNU). Materials & Methods: We performed a retrospective analysis of the ROBUUST database, an international, multicenter registry comprising 4290 patients with UTUC. Patients who underwent RNU for UTUC were included; those with incomplete pathological or follow-up data were excluded. The primary endpoint was metastasis-free survival (MFS); a secondary endpoint was urothelial recurrence-free survival (RFS). Kaplan-Meier (KM) methods were used to estimate survival. Multivariable Cox proportional hazards models assessed the impact of HS on outcomes, adjusting for pathologic T stage (pT), N stage (pN), and tumor grade (WHO 2004/2022). Results: A total of 2,644 patients were included. Median age was 72 years (IQR 65-78) and 1,628 (62%) were male. HS were present in 115 (4.3%) patients, most commonly squamous (54%). Compared to pure urothelial carcinoma (UC), patients with HS were older (median 74 vs 72 years; p=0.006) and had more adverse pathological features: higher ³pT1 disease (72% vs 41%; p<0.0001), high grade (95% vs 82%; p=0.001), and more pN+ disease (20% vs 9%; p=0.001). Median follow-up was 25 months (IQR 11-49). Overall, 763 patients developed urothelial recurrence and 430 developed distant metastases. For RFS, 3-year rates were 53% for HS vs 65% for pure UC (2-year: 57% vs 69%). On multivariable analysis, HS was an independent predictor of recurrence (HR: 1.50; 95% CI: 1.09–2.06; p=0.013). For MFS, 3-year rates were 50% for HS vs 81% for pure UC (2-year: 60% vs 84%). On multivariable analysis, HS was a strong, independent predictor of worse MFS (HR: 2.05; 95% CI: 1.48–2.83; p<0.001). Figure 1 shows KM curves for MFS stratified by the presence (A) and type (B) of HS. Conclusions: In this large, multicenter cohort of UTUC patients, the presence of HS, albeit rare (4.3%), independently predicts worse oncological outcomes. These findings highlight the aggressive nature of HS in UTUC and support their inclusion in risk stratification for adjuvant therapy decisions.
Volume
89
First Page
2
