Abstract
BACKGROUND AND OBJECTIVE: Preoperative EAU guideline criteria stratify Upper tract urinary carcinomas (UTUC) into low- and high-risk groups. Depending on this classification, high-risk patients may receive simultaneous lymphadenectomy (LAD) during robot-assisted radical nephroureterectomy (RANU). This study examines the reliability of such stratification, focusing on oncological outcomes. METHODS: In 60 patients with UTUC who underwent RANU, 38 were stratified as low-risk (63%) and 22 as high-risk (37%) based on preoperative EAU guideline criteria. LAD was performed solely in the high-risk group. RESULTS: In the low-risk group, 19 patients (50%) had non-muscle-invasive (Ta, Tis-T1) disease, 7 (18%) had muscle-invasive, locally confined (T2) disease and 12 (32%) had locally advanced (T3/4) disease. In the high-risk group, results were 11 (50%), 3 (14%) and 8 (36%), with no statistical differences observed. Follow-up (6 to 60 months) showed no significant differences in cancer-specific (p = 0.3) and overall survival (p = 0.8) between groups. Limitations: the small sample size and the retrospective nature. Conclusions and Clinical Implications: The current EAU guideline-based preoperative criteria for UTUC risk stratification demonstrated limited accuracy in identifying high-risk patients undergoing RANU, potentially excluding some patients from receiving LAD. PATIENT SUMMARY: We think that improved preoperative staging and risk stratification tools are needed to better manage patients with upper urinary tract urothelial carcinoma undergoing surgical treatment.