Impact of dialysis on intravesical recurrence and survival outcomes in upper tract urothelial cancer patients undergoing radical nephroureterectomy

Upper tract urothelial carcinoma (UTUC) presents a significant recurrence risk following radical nephroureterectomy (RNU). Patients on dialysis may experience unique clinical trajectories due to uremic states and altered immune responses. To evaluate the impact of dialysis on intravesical recurrence and survival outcomes in patients with UTUC undergoing RNU, and to identify predictive factors influencing prognosis. A retrospective cohort study analyzed 402 patients with non-metastatic UTUC treated with RNU between 2001 and 2014. Patients were stratified into dialysis (<i>n</i> = 66) and non-dialysis (<i>n</i> = 336) groups. Survival and recurrence outcomes were assessed using Kaplan–Meier and Cox regression analyses. Dialysis patients were predominantly female, younger, and exhibited less advanced pathological tumor stages. Dialysis was associated with higher intravesical recurrence rates (<i>p</i> = 0.009), which were largely attributable to a history of bladder cancer (42.4% vs. 26.5%; <i>p</i> = 0.009). After adjustment for bladder cancer history, dialysis was not an independent predictor of bladder recurrence-free survival (BRFS). Advanced pT stages (HR: 3.9, <i>p</i> = 0.012) and prior bladder cancer were the primary factors influencing BRFS. Dialysis does not independently worsen surgical outcomes or BRFS in UTUC patients post-RNU when accounting for prior bladder cancer. Prognostic models should integrate these findings to enhance individualized surveillance and treatment strategies.