All chapters of the 2019 RCC Guidelines have been updated, based on the 2018 version of the Guidelines. References have been added throughout the document.
New data have been included in the following sections, resulting in changed recommendations:
3.4 Recommendations for the management of other renal tumours
| Recommendations | Strength rating |
| Treat Bosniak type III cysts the same as RCC or offer cautious surveillance. | Weak |
| Treat Bosniak type IV cysts the same as RCC. | Strong |
| Offer active surveillance to patients with biopsy-proven oncocytomas, as an acceptable alternative to surgery or ablation. | Weak
|
7.2.5.1 Summary of evidence and recommendations for adjuvant therapy
| Summary of evidence | LE |
| After nephrectomy, in selected high-risk patients, adjuvant sunitinib improved disease-free survival in one of the two available studies, but not overall survival. | 1b
|
| Adjuvant sorafenib, pazopanib or axitinib does not improve disease-free survival or overall survival after nephrectomy. | 1b |
| Recommendations | Strength rating |
| Do not offer adjuvant therapy with sorafenib, pazopanib or axitinib. | Strong |
7.3.1.1.2 Summary of evidence and recommendations for local therapy of advanced/metastatic RCC
| Summary of evidence | LE |
| Cytoreductive nephrectomy followed by sunitinib is non-inferior to sunitinib alone in patients with metastatic ccRCC. | 1a |
| Sunitinib alone is non-inferior compared to immediate cytoreductive nephrectomy followed by sunitinib in patients with MSKCC intermediate and poor risk who require systemic therapy with VEGFR-TKIs. | 1a
|
| Recommendations | Strength rating |
| Do not perform cytoreductive nephrectomy (CN) in MSKCC poor-risk patients. | Strong |
| Do not perform immediate CN in MSKCC intermediate-risk patients who have an asymptomatic synchronous primary tumour and require systemic therapy with vascular endothelial growth factor receptor (VEGFR)-tyrosine kinase inhibitor (TKI). | Weak
|
| Start systemic therapy without CN in MSKCC intermediate-risk patients who have an asymptomatic synchronous primary tumour and require systemic therapy with VEGFR-TKI. | Weak
|
| Discuss delayed CN in MSKCC intermediate-risk patients under VEGFR-TKI therapy who derive long-term sustained benefit and/or minimal residual metastatic burden. | Weak
|
| Perform immediate CN in patients with good performance who do not require systemic therapy. | Weak |
| Perform immediate CN in patients with oligometastases when complete local treatment of the metastases can be achieved. | Weak
|