Objective: This study aims to identify the optimal treatment strategy and conduct a prognostic analysis for patients with locally advanced Upper Tract Urothelial Carcinoma (UTUC). Methods and materials: The study included 3,829 patients diagnosed with pT3-4N0/+M0 UTUC from 2004 to 2015, with data obtained from the SEER database. Patients were randomly assigned to a training group (70%) and a validation group (30%) for nomogram development. For nomogram development, variables that demonstrated statistical significance in univariate analysis (P < 0.05) were selected for inclusion in the multivariate model. The nomogram’s predictive precision and ability to differentiate were evaluated through the C-index, AUC and calibration curves. The model’s clinical validity was confirmed through the use of decision curve analysis (DCA). Results:The 3-year OS and CSS rates were significantly higher in patients who received surgery followed by adjuvant chemotherapy (S+C) compared to those treated with surgery alone (S). Within the pN+ subgroup, the combination of surgery with both adjuvant chemotherapy and radiotherapy (S+R+C) group and S+C group yielded superior results over the S group, with the S+R+C group regimen showing the most favorable outcomes. Multivariate COX regression analysis identified age, primary tumor location, T and N stages, treatment modality, tumor size, and lymph node count as significant predictors of OS and CSS. These factors were integrated into precisely developed nomograms for predicting OS and CSS, with concordance indices of 0.651 and 0.667 in both sets. Conclusion: For patients with UTUC at stage pT3-4M0, adjuvant chemotherapy following surgical treatment has markedly extended patient longevity. Furthermore, for those with pT3-4N+M0 stage UTUC, the addition of radiotherapy to the surgical and chemotherapy regimen has proven to notably enhance survival rates. Our predictive nomogram reliably forecasts OS and CSS rates for patients with locally advanced UTUC.