Contralateral recurrence after surgery for upper tract urothelial carcinoma: Risk factors, timing, and treatment patterns from the ROBUUST 3.0 international registry
Recommended Citation
Ditonno F, Bertolo R, Ghodoussipour S, Mehrazin R, Porpiglia F, Rais-Bahrami S, Ferro M, Perdonà S, Gonzalgo ML, Sundaram CP, Shiota M, Yoshida T, Abdollah F, Minervini A, Simone G, Tuderti G, Margulis V, Lee R, Djaladat H, Singla N, Wu Z, Derweesh IH, Autorino R, Antonelli A. Contralateral recurrence after surgery for upper tract urothelial carcinoma: Risk factors, timing, and treatment patterns from the ROBUUST 3.0 international registry. Eur Urol 2026; 89:1.
Document Type
Conference Proceeding
Publication Date
3-1-2026
Publication Title
Eur Urol
Keywords
Urology & Nephrology
Abstract
Introduction & Objectives: Metachronous contralateral upper tract urothelial carcinoma (UTUC) is an uncommon but clinically significant event after treatment for unilateral disease, often threatening renal preservation. The present abstract aimed at investigating predictors and treatment modalities of contralateral recurrence using propensity score–adjusted analysis in a large international cohort Materials & Methods: Data were extracted from the ROBUUST 3.0 registry, including patients undergoing surgery for UTUC between 2018 and 2025 across >20 academic centres worldwide. Those with prior or synchronous contralateral disease were excluded. The primary endpoint was metachronous contralateral recurrence, defined as any new urothelial tumour in the renal pelvis or ureter opposite to the index side. Patients with contralateral recurrence were matched 1:3 with recurrence-free controls using nearest-neighbour propensity score matching (caliper 0.2 SD). Conditional logistic regression identified independent predictors, and Kaplan–Meier analysis assessed recurrence-free survival. Results: Among 4.289 eligible patients, 3.110 had available follow-up (median 20.8 months, IQR 8.0–43.0). Contralateral metachronous UTUC occurred in 20 patients (0.6%). After 1:3 matching, 80 controls were retained with excellent balance (standardized mean differences <0.08). Patients with contralateral recurrence were older (median 74 vs 71 years) and more frequently ever-smokers (75% vs 53%). Multifocality at initial diagnosis was more common (35% vs 19%), while stage and grade were comparable. Median time to contralateral recurrence was 12.5 months (IQR 8.3–24.0). The recurrence originated in the renal pelvis in 65%, the ureter in 25%, and both sites in 10%. Treatments included radical nephroureterectomy in 13 patients (65%), kidney-sparing endoscopic management in 5 (25%), and segmental ureterectomy in 2 (10%). Conditional logistic regression confirmed ever-smoking as an independent predictor (OR 2.84, 95% CI 1.01–8.03; p=0.048) and multifocality as a near-significant factor (OR 2.47, 95% CI 0.96–6.34; p=0.062). Kaplan–Meier analysis showed higher 2-year contralateral-recurrence rates among smokers and patients with multifocal tumours (4.1% vs 0.9%, p=0.03). Conclusions: Contralateral metachronous UTUC is rare (~0.6%) but typically arises within 18 months post-surgery. Tobacco exposure and multifocality independently predict recurrence, reflecting a field cancerisation effect rather than anatomical determinants. Most recurrences were managed with radical nephroureterectomy; however, one-third underwent kidney-sparing treatment with favourable short-term oncological outcomes. Early, risk-adapted contralateral surveillance and kidney-sparing management may preserve renal function without compromising oncological safety.
Volume
89
First Page
1
