The aim of the present study was to determine the prognostic significance of a novel marker, the red cell distribution width to lymphocyte percentage (RDW‑to‑LYM%) ratio, in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). The clinical and follow‑up data of 625 patients with UTUC receiving RNU were retrospectively analyzed. The optimal cut‑off value of the pre‑treatment RDW‑to‑LYM% ratio was determined as 0.80 using receiver operating characteristic (ROC) analysis according to cancer‑specific death. The associations between low (≤0.80) and high (>0.8) RDW‑to‑LYM% ratio and other clinicopathological parameters were evaluated using the χ2 test and logistic regression analysis. The impact of the RDW‑to‑LYM% ratio on overall survival (OS), cancer‑specific survival (CSS) and progression‑free survival (PFS) rates was assessed using the Kaplan‑Meier method and Cox regression analysis. A high RDW‑to‑LYM% ratio (>0.80) was significantly associated with impaired kidney function, previous/concurrent bladder cancer, tumors involving both the pelvis and ureter, advanced pathological T stage, lymph node involvement and lymphovascular invasion (LVI). Kaplan‑Meier analysis revealed that a high RDW‑to‑LYM% ratio was associated with poorer OS, CSS and PFS than a low RDW‑to‑LYM% ratio (all P<0.001). The multiple logistic regression analysis revealed that high RDW‑to‑LYM% ratio was associated with non‑organ‑confined (NOC) disease [odd ratio (OR), 2.107; 95% confidence interval (CI), 1.446‑3.069; P<0.001] and positive LVI (OR, 1.978; 95% CI, 1.338‑2.916; P<0.001). Furthermore, the multivariate analysis showed that the RDW‑to‑LYM% ratio was an independent factor for predicting OS [hazard ratio (HR), 2.046; P<0.001], CSS (HR, 2.041; P<0.001) and PFS (HR, 1.502; P=0.009). In conclusion, the pre‑treatment RDW‑to‑LYM% ratio was found to be a significant predictor of both NOC and the presence of LVI in patients with UTUC. Moreover, an elevated pre‑treatment RDW‑to‑LYM% ratio was identified as an independent factor for unfavorable survival outcomes in patients with UTUC undergoing RNU.

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