Pelcovits A, Mueller-Leonhard C, Mega A, et al. - A total of 794 individuals aged 18–89 years who underwent radical nephroureterectomy with lymph node dissection for pN+ M0 UTUC from 2006 to 2013 in the National Cancer Database were enrolled by the researchers in order investigate pN+ M0 UTUC to identify its natural history, report trends in utilization of perioperative chemotherapy, and recognize clinicopathologic characteristics related to survival. Neoadjuvant chemotherapy use progressed from 6.7 to 14.2%, whereas adjuvant chemotherapy use persisted to be stable, over the study period. The OS at 1-, 5-, and 8-year were 63.7%, 24.2%, and 18.7%, respectively. Elderly age, bigger tumor size, greater pT stage, positive surgical margins, number of positive LNs, and non-receipt of adjuvant chemotherapy were independently correlated with worse OS. A simplified risk score involving age, tumor size, pT stage, number of positive LNs, and margin status was made with prognosticated 5-year OS varying from 12 to 44%. Therefore, pN+ M0 UTUC was related to a 5-year OS of only 24%. Moreover, clinicopathologic predictors of survival following surgical resection could better risk-stratification, counseling, and choice of patients for multimodal management.