History of Urinary Tract Stones Linked to Worse Outcomes After UTUC Surgery: JAMA
A cohort study has found that patients with upper tract urothelial carcinoma (UTUC) who had a history of urinary tract stones showed poorer cancer-specific survival (CSS) and disease-free survival (DFS), indicating a higher-risk subgroup that may benefit from closer monitoring and tailored adjuvant therapy. The study was published in JAMA Network Open by Bor-En J. and colleagues.
UTUC represents a highly aggressive malignancy, and while surgery remains the mainstay of treatment, identification of prognostic factors predictive of disease outcomes is critical to optimize the management of this cancer. The current multicenter cohort analysis from the Taiwan UTUC Registry aimed to clarify the potential role of a history of urinary stone in influencing long-term survival outcomes of UTUC patients.
This study was carried out as part of the Taiwan UTUC Registry Study, in which 21 tertiary and regional hospitals across Taiwan participated. The medical records from September 1, 1988, to December 31, 2023, were reviewed, with follow-up to December 31, 2024, and statistical analysis between January 15 and March 30, 2025.
A total of 5824 registry patients were reviewed, of whom 3414 patients met the inclusion criteria for having undergone radical nephroureterectomy for histologically confirmed UTUC. The average age of participants was 68.2 years (SD, 10.5 years), and 57.3% (1957 patients) were female. Of the included patients, 169 individuals (4.9%) had a documented history of urinary tract stones. The median follow-up period was 53.86 months (IQR, 23.72–92.50 months).
Results
The analysis revealed that patients with a history of stones in the urinary tract had significantly worse outcomes compared to non-stone cases.
Thus, metastasis developed in 25 (14.8%) patients with stones, as compared with 233 (7.2%) patients without stones.
Additionally, 47 (27.8%) patients with stones died because of UTUC-related causes, as opposed to 599 (18.5%) among those without a stone history.
After adjustment using overlap weighting, stone history was independently associated with worse CSS with a hazard ratio of 1.83 (95% CI, 1.35–2.47; P < .001) and worse DFS with a hazard ratio of 1.69 (95% CI, 1.29–2.21; P < .001).
However, no statistically significant association was indicated between urinary stone history and OS (HR 1.18; 95% CI, 0.94–1.48) or BRFS (HR 1.09; 95% CI, 0.86–1.37).
This study, therefore, underlines the importance of integrating the history of urinary stone into the prognostication and treatment of UTUC patients by clinicians.
Reference:
Jong B, Wu H, Chen W, et al. Kidney Stone History and Survival Outcomes in Upper Tract Urothelial Carcinoma. JAMA Netw Open. 2025;8(11):e2541054. doi:10.1001/jamanetworkopen.2025.41054
