Recent studies in metastatic bladder cancer suggest an overall survival benefit from treating the primary tumor.1 Upper tract urothelial cancer has similar biology to bladder cancer and nephroureterectomy has a lower complication rate; we, therefore, hypothesized that high-intensity local treatment for metastatic upper tract urothelial carcinoma (UTUC) would also be associated with improved overall survival. In our recently published analysis, we used the National Cancer Database (NCDB) to investigate the impact of high-intensity local treatment on overall survival in patients with stage IV UTUC.2