Oncological outcomes of radical nephroureterectomy with or without lymphadenectomy and neoadjuvant therapy in cN+ UTUC: Insights from the ROBUUST registry.
Publication Title
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
Document Type
Article
Publication Date
10-1-2026
Keywords
washington; swedish
Abstract
Objectives: To evaluate the clinical and oncologic outcomes of patients with clinically node-positive (cN+) upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), with or without neoadjuvant therapy (NAT) and lymphadenectomy (LND), using data from the international RObotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) registry.
Methods: This retrospective study queried the ROBUUST registry, including 242 patients with cN + UTUC who underwent RNU between 2017 and 2024 across 17 institutions. Patients were stratified based on receipt of NAT and/or LND. Clinical, pathological, and follow-up data were analyzed. Primary endpoints included overall survival (OS) and cancer-specific survival (CSS), while metastasis-free survival (MFS) was a secondary endpoint. Survival outcomes were estimated using Kaplan-Meier curves and Cox regression analyses.
Results: Among 2733 patients, 242 (8.8%) had cN + disease and were included. Median age was 69 years; 86% underwent LND and 27.6% received NAT. At pathology, 43.7% of LND patients were pN+, and NAT was associated with a higher rate of pN0 status (65% vs. 41%). After a median follow-up of 25.8 months, 12- and 24-month OS were 71% and 60%, respectively. On multivariable analysis, pN + status, tumor location, and ≥pT3 stage were associated with worse OS and CSS, while receipt of NAT was independently associated with improved OS (HR 0.52, p = 0.016) and CSS (HR 0.47, p = 0.020). LND was not independently associated with survival benefit. Sensitivity analysis showed improved OS in patients receiving both NAT and LND compared to LND alone.
Conclusions: In patients with cN + UTUC, NU as part of a multimodal strategy was associated with favorable short-term oncologic outcomes. Neoadjuvant therapy significantly improved survival, supporting its integration into the treatment paradigm for this high-risk group. Further prospective studies are warranted to optimize patient selection and treatment sequencing.
Area of Special Interest
Cancer
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Oncology
Specialty/Research Institute
Nephrology
Specialty/Research Institute
Urology
DOI
10.1016/j.ejso.2026.112033
