Comparison of clinical outcomes of upper tract urothelial carcinoma between patients after renal transplantation and on dialysis

Purpose: Upper tract urothelial carcinoma (UTUC) is an uncommon complication following renal replacement therapy in Chinese patients with end-stage renal disease (ESRD). The study aims to determine differences in clinical outcomes between patients who have undergone renal transplantation (RT) and those on dialysis. Materials and Methods: We conducted a retrospective analysis including the clinicopathological data of 34 patients who received RT and 90 patients on dialysis, all were diagnosed with unilateral UTUC at our center. We aimed to identify differences in clinical and pathological features between the two groups. The analysis employed the Kaplan-Meier method for survival analysis and propensity score matching (PSM) to account for potential biases in the selection of surgical approaches. Results: The RT group comprised a higher proportion of younger patients and exhibited a higher prevalence of larger tumors and adenoid differentiation. The Kaplan-Meier curves showed significant differences in contralateral recurrence-free survival (CRFS) and cancer-specific survival (CSS) between the two groups. However, no significant differences were observed in overall survival (OS), bladder recurrence-free survival, or metastasis-free survival. After PSM, significant differences in CRFS and CSS remained. A multivariate Cox regression analysis identified RT as an independent predictor of poor CRFS outcomes. Conclusion: RT is associated with comparable OS to dialysis in patients with ESRD, but there is a potential increased risk of contralateral recurrence. The prophylactic contralateral nephroureterectomy is a priority choice for UTUC patients following RT in certain regions.