Foerster B, Abufaraj M, Matin SF, et al. - Features to identify low-risk patients who may benefit from endoscopic kidney-sparing surgery in upper tract urothelial carcinoma (UTUC), are described by several groups. In this study, standard risk stratification features are evaluated along with the development of an optimal model to identify ≥ pT2/N+ stage at radical nephroureterectomy (RNU).

• A collaborative retrospective study of 1,214 patients undergoing ureterorenoscopy with biopsy followed by RNU for nonmetastatic UTUC.

• Multiple imputation of chained equations was performed for missing data and multivariable logistic regression analysis with a stepwise selection algorithm was done to generate the optimal predictive model.

• In the multivariable logistic regression analysis of this model, ≥ pT2/pN+ disease was observed in significant correlation with age, high-grade biopsy, biopsy cT1+ staging, preoperative hydronephrosis, tumor size, invasion on imaging, and sessile architecture.

• This model exhibited the highest performance accuracy (75% vs 66–71%) and an additional clinical net reduction (four per 100 patients) when compared with the existing models.