A new analysis of outcomes of adjuvant chemotherapy compared with observation in 1,544 patients with upper tract urothelial carcinoma (UTUC) from 15 centres who had undergone radical nephroureterectomy demonstrated no difference in overall survival between the two groups (HR 1.14, 95%CI 0.91–1.43; P = 0.268). The benefit from adjuvant chemotherapy in these patients remains unclear and dedicated trials and improved patient selection criteria are still needed.