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Methods: A retrospective cohort study was conducted including 342 patients who underwent radical nephroureterectomy.
Kaplan-Meier method and Log-Rank test were used to assess survival. Cox regression analysis was used to determine the
impact of different factors on cancer-specific survival after radical nephroureterectomy.

Results: The study cohort consisted of 342 patients, with a mean follow-up time after radical nephroureterectomy of 32.5
(6-154) months. The 5-year CSS was 64% for this patient cohort. During the follow-up period, a total of 128 (37.4%) patients
died, including 92 (28.2%) patients who died due to urothelial carcinoma. Multivariate analysis showed that the pathological
stage of the primary tumor (HR, 11.1; 95% CI 3.64-33.8; P=0.001), presence of positive lymph nodes (HR, 2.04; 95% CI 1.05-
3.94; P=0.03) and preoperative anemia (HR, 3.50; 95% CI 2.02-6.08; P=0.001) were independent predictors significantly
associated with worse CSS. Patients with disease stage ≤ pT2 had significantly better CSS compared to patients with disease
stage ≥ pT3 (P=0.001, Log-Rank test). The average CSS for patients with positive lymph nodes (pN+) was 22.1 ± 5.1 months
(95% confidence interval from 12.1-32.2).

Conclusion: Preoperative anemia, pathological disease stage, and presence of positive lymph nodes are significant
independent prognostic predictors of CSS in patients who underwent radical nephroureterectomy.

Keywords: upper urothelial tumors, cancer-specific survival, prognostic factors, radical nephroureterectomy

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