Evaluation of Upper TRACT Endometry Score for Predicting Endoscopic Management Complexity and Success in Upper Tract Urothelial Carcinoma: Results from a Multicenter Study

INTRODUCTION: The Upper TRACT Endometry Score is a novel tool developed and internally validated to communicate tumor complexity and success of endoscopic management (EM) to treat upper tract urothelial carcinoma (UTUC). The aim of this study was to independently evaluate the association of the score to complexity and EM technical success in a contemporary multicenter cohort of UTUC patients. METHODS: This multicenter retrospective study included histologically confirmed UTUC patients treated in the endourology units of two tertiary centers between 2021-2025. Exclusion criteria included those with metastatic or locally advanced disease, carcinoma in-situ, recent prior UTUC treatment, or insufficient follow-up. The Endometry score (0-9) was calculated for each patient and was stratified into 3 risk groups. EM extent (1-6), representing the outcome of complexity and technical success to control the disease endoscopically, was collected and classified into 3 grades. The linear-by-linear association test (Mantel test for trend) and ordinal logistic regression were used to compare EM outcomes across score risk groups. RESULTS: The study cohort consisted of 66 patients fulfilling selection criteria. Our cohort had a greater burden of prior UC and more high-grade tumors compared with the original cohort of the Endomtery study (44% vs. 9%, p<0.001), however, the distribution of risk groups did not differ between the cohorts. EM extent differed significantly across risk groups (p=0.016), with low-risk patients primarily managed endoscopically (74%) and high-risk patients more frequently requiring radical surgery (55%). Each one-category increase in Endometry risk group was associated with a twofold increase in the odds of a higher EM extent grade (OR 2.015, p=0.017). CONCLUSION: The Upper TRACT Endometry Score shows promise in predicting tumor complexity and success in disease control by EM among UTUC patients, potentially aiding treatment selection. Larger validation studies are needed to confirm its clinical utility and support its incorporation into guidelines.