ArticleInternational urology and nephrology2026
Occult pT2-4 disease and postoperative loss of full-dose cisplatin eligibility in CT-staged cT≤1/cN0 upper tract urothelial carcinoma.
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeIn upper tract urothelial carcinoma (UTUC), selecting candidates for perioperative chemotherapy is difficult because preoperative staging is inaccurate and nephro-ureterectomy lowers renal function. We assessed the frequency and prognosis of occult pT2-4 disease and the postoperative loss of full-dose cisplatin eligibility in radiographically non-locally advanced UTUC.
methodsWe retrospectively reviewed 280 surgically treated UTUC patients (1995-2024). The primary cohort comprised cM0/cN0/cT≤1 (CT-based) patients who underwent upfront radical nephro-ureterectomy without neoadjuvant therapy (n=173). The primary endpoint was occult pT2-4 disease; pN+ was descriptive.
resultsOccult pT2-4 disease occurred in 85 of 173 patients (49.1%) but declined across eras, reaching 23.8% in 2020-2024; pN+ was found in 4 of 32 lymphadenectomy-evaluable patients. Occult disease was associated with lower 5-year overall survival (58% vs 78%; adjusted hazard ratio 1.96, 95% CI 1.17-3.29). Among baseline full-dose-eligible occult-disease patients with postoperative data (n=27), 18 (66.7%) fell below the full-dose threshold and 1 (3.7%) became renally ineligible; this missed full-dose cisplatin window affected 18 of 173 patients (10.4%).
conclusionOccult pT2-4 disease persisted in the contemporary era and was associated with worse overall survival although the pooled rate overstated current risk. Complete renal ineligibility was rare; the predominant change was a shift from the full-dose to the split-dose renal-function range. Because neoadjuvant chemotherapy was not evaluated, these findings indicate a need for better preoperative staging and prospective study rather than a treatment recommendation.
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