Kidney Stone History and Survival Outcomes in Upper Tract Urothelial Carcinoma.

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.