Long-term evidence on endoscopic kidney-sparing surgery for upper tract urothelial carcinoma remains limited, particularly regarding recurrence, metastatic progression, subsequent radical nephroureterectomy, cancer-specific mortality, and renal function.
A large single-center cohort has now provided long-term oncological and functional benchmarks for patients treated with endoscopic kidney-sparing surgery, with outcomes evaluated according to European Association of Urology risk classification.
The article, titled “Endoscopic Kidney-sparing Surgery for Upper Tract Urothelial Carcinoma: Long-term Oncological and Functional Outcomes from a Large Single-center Cohort,” was published online as an article in press in European Urology Oncology on July 3, 2026.
Authors: Pietro Scilipoti, Federico Zorzi, Letizia Maria Ippolita Jannello, Stefano Moretto, Alejandra Bravo-Balado, Alberto Quarà, George Abi Tayeh, Ahmed Alanazi, Ugo Gradilone, Hubert Werth, Marie Chicaud, Laurent Berthe, Luigi Candela, Steeve Doizi, Frédéric Panthier, and Olivier Traxer.
Study Design
The investigators retrospectively analyzed a prospectively maintained cohort of patients treated between August 1996 and September 2024.
Patients were excluded if they underwent upfront radical nephroureterectomy following diagnostic ureteroscopy, had missing pathology from the index procedure, or lacked oncological follow-up.
The final analysis included 254 patients treated with endoscopic kidney-sparing surgery.
Patients were classified as having low-risk or high-risk disease according to EAU criteria and underwent standardized surveillance, including second-look ureteroscopy at 4–6 weeks and long-term ureteroscopic follow-up.
The study evaluated upper tract urothelial carcinoma recurrence, subsequent radical nephroureterectomy, metastatic progression, cancer-specific mortality, and development of chronic kidney disease stage IIIB or higher. Cumulative incidence functions and Fine–Gray competing-risk regression were used for the statistical analyses.
Patient Characteristics
The median age of the study population was 71 years, with an interquartile range of 62–77 years. Overall, 74% of patients were male, and 46% were classified as having low-risk disease. Among surviving patients, the median follow-up was 67 months, with an interquartile range of 24–131 months.
Recurrence Remained Frequent
The cumulative incidence of upper tract urothelial carcinoma recurrence was 49% at 5 years, with a 95% confidence interval of 42–57%, and 55% at 7 years, with a 95% confidence interval of 47–63%. There was no statistically significant difference in recurrence between the low-risk and high-risk groups. The subdistribution hazard ratio was 0.74, with a 95% confidence interval of 0.51–1.08 and a p value of 0.12.
Recurrence remained common following endoscopic kidney-sparing surgery, with no statistically significant difference between the EAU risk groups.
Risk of Radical Nephroureterectomy
Although recurrence incidence did not differ significantly between the two groups, high-risk disease was associated with a greater likelihood of subsequent radical nephroureterectomy.
At 7 years, the cumulative risk of radical nephroureterectomy was 35% among patients with high-risk disease and 13% among those with low-risk disease.
High-risk classification was associated with more than twice the hazard of radical nephroureterectomy, with a subdistribution hazard ratio of 2.30 and a 95% confidence interval of 1.34–3.94. The probability of conversion to radical nephroureterectomy was therefore considerably higher among patients with high-risk disease.
Metastatic Progression
High-risk disease was also associated with a higher hazard of metastatic progression. At 7 years, the cumulative incidence of metastatic progression was 17% in the high-risk group and 5.0% in the low-risk group.
The subdistribution hazard ratio was 2.79, with a 95% confidence interval of 1.10–7.08. Although recurrence incidence did not differ significantly between the risk groups, high-risk disease was associated with a higher hazard of metastatic progression.
Cancer-specific Mortality
A similar difference was observed for cancer-specific mortality. At 7 years, the cumulative incidence of cancer-specific mortality was 23% among patients with high-risk disease and 11% among those with low-risk disease.
High-risk classification was associated with more than twice the hazard of cancer-specific mortality, with a subdistribution hazard ratio of 2.24 and a 95% confidence interval of 1.10–4.55.
Although recurrence incidence did not differ significantly between the risk groups, high-risk disease was associated with higher hazards of metastatic progression and cancer-specific mortality.
Renal Function Outcomes
The study also evaluated long-term renal function after endoscopic kidney-sparing surgery. The median change in estimated glomerular filtration rate was −9 mL/min/1.73 m², with an interquartile range of −11 to −2 mL/min/1.73 m².
The cumulative incidence of chronic kidney disease stage IIIB or higher was 15% at 5 years, with a 95% confidence interval of 8–21%.
There was no statistically significant difference between the risk groups. The subdistribution hazard ratio was 1.63, with a 95% confidence interval of 0.72–3.70 and a p value of 0.20. These results provide a long-term functional benchmark for patients undergoing endoscopic kidney-sparing surgery.
Clinical Implications
The findings reinforce the need for risk-adapted, prolonged endoscopic surveillance after endoscopic kidney-sparing surgery. Risk classification did not significantly distinguish patients according to recurrence incidence. However, high-risk disease was associated with higher hazards of subsequent radical nephroureterectomy, metastatic progression, and cancer-specific mortality.
These findings provide clinically relevant benchmarks for counselling patients with high-risk disease about the higher hazards of radical nephroureterectomy, metastatic progression, and cancer-specific mortality. This was a retrospective analysis of a prospectively maintained single-center cohort.
Takeaway
In this cohort of 254 patients treated with endoscopic kidney-sparing surgery, upper tract urothelial carcinoma recurrence remained frequent, reaching 55% at 7 years. Although recurrence did not differ significantly between EAU risk groups, high-risk disease was associated with higher hazards of radical nephroureterectomy, metastatic progression, and cancer-specific mortality.
These long-term findings provide real-world benchmarks for patient counselling, support the prognostic value of EAU risk stratification, and emphasize the need for prolonged, risk-adapted endoscopic surveillance after kidney-sparing treatment.
Read the full article in European Urology Oncology.
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