Background/Objectives:The accurate preoperative prediction of lymph node (LN) metastasis is essential to optimizing surgical management in renal pelvis urothelial carcinoma (RPUC) and ureteral urothelial carcinoma (UUC). This study evaluates the predictive value of preoperative computed tomography (CT) findings in detecting LN metastasis and determining primary metastatic LN location based on the tumor site.Methods:This retrospective study included 48 RPUC and 97 UUC patients who underwent surgery with lymph node dissection (LND) between 2005 and 2023. Preoperative CT images were assessed for tumor size, location, multifocality, peritumoral fat infiltration, hydronephrosis grade, LN status, and metastatic LN location. Logistic regression and receiver operating characteristic (ROC) curve analyses identified predictive factors for LN metastasis, while Pearson’s chi-square and Fisher’s exact tests determined the association between locations of LN metastasis and primary tumor sites after categorizing UUC into upper and lower UUC.Results:In RPUC, 13 of 48 patients had LN metastasis, with tumor size and peritumoral fat infiltration emerging as significant predictors (p< 0.05). In UUC, 39 of 97 patients had LN metastasis, with tumor size and hydronephrosis grade being significant predictors (p< 0.001). An optimal tumor size threshold of 4 cm was identified for predicting LN metastasis in UUC, and 4.4 cm for RPUC. Additionally, a hydronephrosis grade of 3 or higher was found to be a strong predictor in UUC. ROC analysis showed high accuracy, yielding an AUC of 0.907 in RPUC and 0.904 in UUC. Cross-validation supported the robustness of these findings. Primary LN metastatic sites were predominantly ipsilateral hilar nodes in RPUC and ipsilateral pelvic nodes in lower UUC (p< 0.001).Conclusions:Preoperative CT imaging provides a reliable, noninvasive tool for predicting LN metastasis in RPUC and UUC. Identifying key imaging-based predictors can facilitate risk stratification and surgical decision-making, particularly regarding the necessity and extent of LND.
**背景/目的：** 准确术前预测淋巴结（LN）转移对于优化肾盂尿路上皮癌（RPUC）和输尿管尿路上皮癌（UUC）的手术治疗至关重要。本研究评估术前计算机断层扫描（CT）结果在检测LN转移以及根据肿瘤部位确定主要转移性LN位置方面的预测价值。 **方法：** 这项回顾性研究纳入了2005年至2023年间接受手术及淋巴结清扫术（LND）的48例RPUC患者和97例UUC患者。术前CT图像评估内容包括：肿瘤大小、位置、多灶性、瘤周脂肪浸润、肾积水程度、LN状态以及转移性LN位置。采用逻辑回归和受试者工作特征（ROC）曲线分析确定LN转移的预测因素，同时将UUC分为上段和下段后，使用皮尔逊卡方检验和费希尔精确检验分析LN转移位置与原发性肿瘤部位之间的关联。 **结果：** 在RPUC患者中，48例中有13例出现LN转移，肿瘤大小和瘤周脂肪浸润是显著预测因素（p < 0.05）。在UUC患者中，97例中有39例出现LN转移，肿瘤大小和肾积水程度是显著预测因素（p < 0.001）。研究发现，预测UUC患者LN转移的最佳肿瘤大小阈值为4 cm，RPUC患者为4.4 cm。此外，肾积水程度≥3级是UUC的强预测因子。ROC分析显示预测准确性高，RPUC的曲线下面积（AUC）为0.907，UUC为0.904。交叉验证支持了这些结果的稳健性。原发性LN转移部位在RPUC中主要为同侧肾门淋巴结，在下段UUC中主要为同侧盆腔淋巴结（p < 0.001）。 **结论：** 术前CT成像为预测RPUC和UUC的LN转移提供了一种可靠、无创的工具。识别关键的基于影像学的预测因素有助于进行风险分层和手术决策，特别是关于LND的必要性和范围。
肿瘤(癌症)患者之家