INTRODUCTION AND OBJECTIVES: To evaluate the prognostic role of modified Glasgow prognostic score (mGPS) for the prediction of oncological outcomes in a retrospective large multicenter cohort of upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analyzed a multicenter cohort of patients treated with RNU for clinically nonmetastatic UTUC. Multivariable logistic regression analyses were performed to evaluate the ability of mGPS to predict nonorgan confined (NOC) disease and lymph-node involvement (LNI) at RNU. Multivariable Cox-regression models were performed to evaluate the preoperative and postoperative prognostic effect of mGPS on survival outcomes. RESULTS: Overall, 2,492 patients were included in the study. Of these, 1,929 (77%), 530 (21%), and 33 (1%) had a mGPS of 0, 1, and 2, respectively. mGPS was associated with characteristics of tumor aggressiveness and independently predicted LNI and NOC at RNU (both P < 0.05). On univariable and multivariable Cox-regression analyses, higher mGPS was independently associated with recurrence-free, cancer-specific, and overall survival, both in a preoperative and in a postoperative setting. The inclusion of mGPS significantly improved the discrimination of a preoperative model for the prediction of oncologic outcomes compared to standard prognosticators. CONCLUSIONS: We found that mGPS is independently associated with clinicopathologic features and survival outcomes after RNU. Future studies should investigate the role of mGPS in a panel of preoperative markers for the prediction of NOC and LNI in UTUC patients, thus possibly improving the selection for perioperative systemic therapy.

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Jagiellonian University Krakow Poland

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Medical University of Vienna Vienna Austria; Department of Urology University of Texas Southwestern Medical Center Dallas USA; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia; Department of Urology Weill Cornell Medical College New York USA

Department of Urology Medical University of Vienna Vienna Austria; Klinik für Urologie Luzerner Kantonsspital Lucerne Switzerland

Department of Urology University of Montreal Montreal Canada

Department of Urology University of Rennes Rennes France

Department of Urology University of Texas Southwestern Medical Center Dallas USA

Department of Urology Urological Research Institute Vita Salute University San Raffaele Scientific Institute Milan Italy

Division of Urology Department of Surgical Sciences Torino School of Medicine Torino Italy

Division of Urology Department of Surgical Sciences Torino School of Medicine Torino Italy; Department of Urology Medical University of Vienna Vienna Austria

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Sorbonne Université GRC n°5 ONCOTYPE URO AP HP Hôpital Pitié Salpêtrière Paris France

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Diagnostic challenges and treatment strategies in the management of upper-tract urothelial carcinoma