Purpose: Metastatic recurrence takes place in more than 21.7% of patients with UTUC underwent RNU. Although metastatic recurrence suggested a poor prognosis, the effect of the specific recurrence site on prognosis is still to be discussed.Methods: According to a retrospective analysis on 355 patients who underwent RNU for high-grade, node-negative upper urothelial carcinoma in our hospital from 2010 to 2020. The result showed that no one received neoadjuvant or adjuvant chemotherapy. So,

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... ate and multivariate Cox regression analyses were then performed to assess predictors of metastatic recurrence as well as site-specific prognosis. In addition, Kaplan-Meier method and log-rank test were adopted for the estimation and comparison of the recurrence site-specific survival probabilities after metastatic recurrence.Results: Of 355 patients, 77 recurred during a median follow-up of 17 months. In multivariate analysis, IVR, tumor size, and pT-stage were significant predictors of metastatic recurrence. Metastatic recurrence was most common in bone and multiple sites, with less median survival time for liver recurrence and multiple site recurrence.Conclusion: A majority of patients with high-grade UTUC suffered from systematical recurrence after RNU. IVR, tumor size, and pT-stage are predictors of metastasis and recurrence. Besides, prevention of IVR after RNU may help improve the prognosis of patients with UTUC. Poor prognosis showed compared with other sites, liver, bone and multiple sites relapse relatively quickly. These findings are of great likelihood to contribute to the development of future site-specific treatment plans for recurrence. Plus, studying the genetic association of UTUC and elucidating the underlying mechanism of metastasis recurrence must be of paramount importance.