Risk Assessment of Non‐Urinary Tract Recurrence After Radical Nephroureterectomy Based on <scp>CheckMate</scp> 274 Trial Eligibility: A Multicenter Retrospective Study

OBJECTIVES: To assess the risk of non-urinary tract recurrence after radical nephroureterectomy for patients with upper urinary tract carcinoma according to CheckMate 274 trial eligibility. METHODS: We evaluated patients who underwent radical nephroureterectomy between 2012 and 2022 for upper urinary tract carcinoma. Recurrence was defined as extra-urinary tract recurrence. Univariate and multivariable analyses were used to determine the risk factors for recurrence according to CheckMate 274 trial eligibility. RESULTS: Among 545 patients, 127 (23.3%) experienced recurrence during the follow-up period. Three-hundred sixty two (66.4%) patients were not eligible for CheckMate 274 trial criteria while 183 (33.6%) patients were eligible. The multivariable analysis demonstrated that preoperative renal dysfunction (HR2.24, 95% CI: 1.37-3.65, p = 0.001), presence of lymphovascular invasion (HR1.89, 95% CI: 1.18-3.00, p = 0.008)., positive resection margin (HR2.58, 95% CI: 1.43-4.66, p = 0.002), positive lymph node status (HR: 2.34, 95% CI: 1.21-4.55, p = 0.012) were risk factors for CheckMate 274 eligible patients. On the other hand, among 362 ineligible patients, performing preoperative diagnostic ureteroscopy (HR 3.09, 95% CI: 1.55-6.17, p = 0.001), presence of lymphovascular invasion (HR3.81, 95% CI: 1.78-8.17, p < 0.001), presence of histological subtype (HR4.82, 95% CI: 1.91-12.13, p < 0.001) and pathological T2 stage (HR2.28, 95% CI: 1.08-4.81, p = 0.031) were risk factors for recurrence. CONCLUSIONS: According to our study, it may be possible to discuss the needs of adjuvant treatment in each individual. These findings provide a basis for more informed decisions regarding adjuvant therapy in UTUC, with the potential to reduce unnecessary treatment.