Based on the results of a multicenter retrospective cohort study published in JAMA Network Open, in patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma, a history of urinary stones was associated with significantly worse cancer-specific and disease-free survival. This held true even after adjusting for confounders using overlap weighting, according to Jong et al.  

“These findings suggest that patients with upper tract urothelial carcinoma and stone history may represent a high-risk subgroup requiring intensified surveillance and potentially tailored adjuvant therapy,” the investigators commented.

Study Details

A total of 3,414 patients from the multicenter Taiwan Upper Tract Urothelial Carcinoma (UTUC) Registry Study (mean age = 68.2 years; female: n = 1,957 [57.3%]) who underwent radical nephroureterectomy for upper tract urothelial carcinoma were included in analysis. Of this population, 169 (4.9%) had a history of urinary stones.

Medical records from September 1988 to December 2023, were reviewed; follow-up continued through December 31, 2024, and data were analyzed from January 15 to March 30, 2025.  Follow-up data were provided for a median of 53.9 months.

Cancer-specific and disease-free survival were evaluated as the primary outcomes. Secondary outcomes included overall and bladder recurrence–free survival.

Key Findings

Patients with vs without a history of urinary stones appeared to have higher rates of metastasis (14.8% vs 7.2%) and upper tract urothelial carcinoma–specific death (27.8% vs 18.5%). After overlap weighting, stone history was found to be independently associated with worse cancer-specific (hazard ratio [HR] = 1.83, 95% confidence interval [CI] = 1.35–2.47; P < .001) and disease-free (HR = 1.69, 95% CI = 1.29–2.21; P < .001) survival. Stone history did not seem to be significantly associated with overall (HR = 1.18, 95% CI = 0.94–1.48) or bladder recurrence–free (HR = 1.09, 95% CI = 0.86–1.37) survival.

The investigators concluded, “In this cohort study of patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy, a history of urinary tract stones was associated with higher upper tract urothelial carcinoma–specific mortality and a greater risk of disease recurrence. Although the association with overall survival was less certain after adjusting, these findings suggest that patients with upper tract urothelial carcinoma and urinary tract stone history represented a distinctly high-risk subgroup.”

Regarding future implications, they stated, “Enhanced surveillance and risk-directed therapies may help offset the negative prognostic outcomes associated with stone disease, and future investigations should focus on unraveling the molecular basis of this association and optimizing personalized management for these patients.”

Yao-Chou Tsai, MD, PhD, of Taipei Tzu Chi Hospital, New Taipei City, Taiwan, is the corresponding author of the article in JAMA Network Open.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.