A new multicentre study from Taiwan has revealed that patients with upper tract urothelial carcinoma (UTUC) who have a history of urinary tract stones face significantly poorer cancer outcomes than those without a history. The findings, published in 2025 as part of the Taiwan UTUC Registry Study, highlight a potentially high-risk subgroup of UTUC patients who may benefit from closer follow-up and individualised postoperative treatment strategies.
UTUC, a relatively uncommon but aggressive form of urinary cancer affecting the lining of the kidney and ureter, is typically treated with radical nephroureterectomy (RNU): surgical removal of the kidney, ureter, and surrounding tissue. However, factors influencing survival after surgery remain incompletely understood.
Urothelial Carcinoma Outcomes Worsen in Patients with Stone History
The study analysed data from 3,414 patients who underwent RNU between 1988 and 2023 across 21 Taiwanese hospitals. Of these, 169 patients (4.9%) had a documented history of urinary tract stones. Researchers used overlap weighting, a statistical method that adjusts for baseline differences between patient groups, to reduce confounding.
Results showed that patients with a stone history had higher rates of metastasis (14.8% vs. 7.2%) and cancer-specific death (27.8% vs. 18.5%) compared with those without stones. After adjustment, stone history was independently associated with worse cancer-specific survival (hazard ratio [HR], 1.83) and disease-free survival (HR, 1.69), both highly significant. Interestingly, there were no significant differences in overall survival or bladder recurrence–free survival between the two groups.
Researchers suggest that the chronic inflammation, urinary stasis, or recurrent infections associated with urinary stones might contribute to tumour aggressiveness or resistance to therapy.
Experts Urge Closer Monitoring and Tailored Therapies for Affected Patients
Lead investigators emphasised that UTUC patients with a history of stones may represent a distinct high-risk subgroup, warranting more intensive postoperative surveillance and possibly tailored adjuvant therapy to improve outcomes.
The study also demonstrates the need for clinicians to consider stone history as a prognostic factor in UTUC management and calls for further research into the biological mechanisms linking urinary stones with worse cancer behaviour.
Reference
Jong B et al. Kidney stone history and survival outcomes in upper tract urothelial carcinoma. JAMA Netw Open. 2025;8(11):e2541054.
