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Objective: We investigated the prognostic significance of tumor necrosis in primary transitional cell carcinoma (TCC) of upper urinary tract. Methods: We retrospectively analyzed the records of 119 patients who received surgical management for primary TCC of upper urinary tract. The presence or absence of tumor necrosis was evaluated based on the macroscopic description of the tumor. Along with pathologic features of tumor necrosis, we assessed the impacts of various prognostic factors previously reported for TCC of upper urinary tract. Results: Tumor necrosis was identified in 19 (16.0%) patients. Patients with tumor necrosis were more likely to have higher local stage, nodal involvement, higher tumor grade, lymphovascular invasion (LVI), and recurrence of disease. Among all subjects, disease-specific survival rates at 5 years after surgery for patients with and without macroscopic tumor necrosis were 36.7 and 83.2%, respectively (P ¼ 0.0001). In multivariate analysis, only pathologic T stage, LVI and tumor necrosis were shown to be independent predictors for disease-specific survival. For solely the invasive tumors, variables including age, surgical margin and tumor necrosis were observed to be independent prognostic factors for disease-specific survival in multivariate analysis, with tumor necrosis showing the highest rank order of statistical significance. Conclusions: Our results suggest that macroscopic tumor necrosis may be a useful prognostic indicator for primary TCC of upper urinary, especially for invasive tumors. Further investigation would be warranted for the prognostic implications of tumor necrosis in TCCs of upper urinary tract and on actual pathogenesis of tumor necrosis in upper tract TCC.