Researchers identified flank pain (FP) in the absence of gross hematuria (GH) as a prognostic risk factor in patients with upper tract urothelial carcinoma (UTUC). They presented this and other findings, in addition to a prognostic risk model, in a report published in the journal Clinical Medicine Insights: Oncology.

The researchers performed a retrospective analysis of patients with nonmetastatic UTUC who had been treated with radical nephroureterectomy at Huadong Hospital Affiliated to Fudan University in Shanghai, China. The researchers categorized patients into 4 subgroups based on the following features: presence of GH without FP, presence of FP without GH, absence of both FP and GH, or presence of both FP and GH. The researchers analyzed long-term outcomes for these subgroups, in addition to other characteristics, and developed a prognostic model.

The researchers analyzed data from 179 patients, and these patients formed a training cohort for constructing the model. The researchers then evaluated model performance with a validation cohort that included 146 patients.

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In the training cohort, 30.7% of patients had FP, and 71.5% had GH. With a median follow-up duration of 47 months, 21.2% of patients in this cohort died from UTUC and 7.3% of patients died from other causes.

The researchers found that presence of FP was associated with significantly worse oncologic outcomes than absence of FP (P <.05). Also, in analyses of the 4 patient subgroups, those experiencing FP without GH had the poorest survival outcomes.

Multivariate analysis of subgroups revealed independent risk factors for cancer-specific survival (CSS). These included having FP without GH (hazard ratio [HR], 5.495; 95% CI, 2.423-12.461; P <.001), pathologic stage (HR, 3.744; 95% CI, 1.529-9.168; P =.004), and presence of tumor multifocality (HR, 2.740; 95% CI, 1.355-5.540; P =.005).

The researchers established a risk stratification model based on these risk factors, with a low-risk group (having none of these risk factors), an intermediate-risk group (having 1 of these risk factors), and a high-risk group (having 2 or more of these risk factors).

Within the training cohort, the 3-year CSS rates were 97.7% in the low-risk group, 83.5% in the intermediate-risk group, and 43.6% in the high-risk group. The 5-year CSS rates were 94.4%, 79.0%, and 25.8%, respectively. Differences in CSS estimates in the training cohort using this model were significant (P <.001).

In a test of the model with the validation cohort, 3-year CSS rates were 92.8% in the low-risk group, 66.7% in the intermediate-risk group, and 40.8% in the high-risk group. The 5-year CSS rates were estimated to be 89.7%, 63.5%, and 37.2%, respectively. CSS differences in this cohort also were significant (P <.001).

“Flank pain was significantly associated with poor oncological outcomes, but no differences were noted between GH and oncological outcomes,” the researchers concluded in their report.


Sun KN, Wu JH, Chen ZH, et al. Predictive value of flank pain and gross hematuria on long-term survival in patients with upper tract urothelial carcinoma treated by radical nephroureterectomy. Clin Med Insights Oncol. Published online January 16, 2023. doi:10.1177/11795549221147993