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European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update
Authors:Börje Ljungberg  Laurance Albiges  Yasmin Abu-Ghanem  Karim Bensalah  Saeed Dabestani  Sergio Fernández-Pello Montes  Rachel H. Giles  Fabian Hofmann  Milan Hora  Markus A. Kuczyk  Teele Kuusk  Thomas B. Lam  Lorenzo Marconi  Axel S. Merseburger  Thomas Powles  Michael Staehler  Rana Tahbaz  Alessandro Volpe  Axel Bex
Affiliation:1. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden;2. Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France;3. Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel;4. Department of Urology, University of Rennes, Rennes, France;5. Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden;6. Department of Urology, Cabueñes University Hospital, Gijón, Spain;7. Department of Nephrology and Hypertension, Patient Advocate International Kidney Cancer Coalition (IKCC), University Medical Center Utrecht, Utrecht, The Netherlands;8. Department of Urology, Sunderby Hospital, Sunderby, Sweden;9. Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic;10. Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany;11. Department of Urology, Royal Free Hospital, Pond Street, London, UK;12. Academic Urology Unit, University of Aberdeen, Aberdeen, UK;13. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK;14. Department of Urology, Coimbra University Hospital, Coimbra, Portugal;15. Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany;p. The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK;q. Department of Urology, Ludwig-Maximilians University, Munich, Germany;r. Department of Urology, University Hospital Hamburg Eppendorf, Hamburg, Germany;s. Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy;t. The Royal Free London NHS Foundation Trust, London, UK;u. UCL Division of Surgery and Interventional Science, London, UK;v. Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Abstract:

Context

The European Association of Urology Renal Cell Carcinoma (RCC) Guideline Panel has prepared evidence-based guidelines and recommendations for the management of RCC.

Objective

To provide an updated RCC guideline based on standardised methodology including systematic reviews, which is robust, transparent, reproducible, and reliable.

Evidence acquisition

For the 2019 update, evidence synthesis was undertaken based on a comprehensive and structured literature assessment for new and relevant data. Where necessary, formal systematic reviews adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were undertaken. Relevant databases (Medline, Cochrane Libraries, trial registries, conference proceedings) were searched until June 2018, including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm, systematic reviews, and meta-analyses. Where relevant, risk of bias (RoB) assessment, and qualitative and quantitative syntheses of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Clinical practice recommendations were developed and issued based on the modified GRADE framework.

Evidence synthesis

All chapters of the RCC guidelines were updated based on a structured literature assessment, for prioritised topics based on the availability of robust data. For RCTs, RoB was low across studies. For most non-RCTs, clinical and methodological heterogeneity prevented pooling of data. The majority of included studies were retrospective with matched or unmatched cohorts, based on single- or multi-institutional data or national registries. The exception was for the treatment of metastatic RCC, for which there were several large RCTs, resulting in recommendations based on higher levels of evidence.

Conclusions

The 2019 RCC guidelines have been updated by the multidisciplinary panel using the highest methodological standards. These guidelines provide the most reliable contemporary evidence base for the management of RCC in 2019.

Patient summary

The European Association of Urology Renal Cell Carcinoma Guideline Panel has thoroughly evaluated the available research data on kidney cancer to establish international standards for the care of kidney cancer patients.
Keywords:Renal cell cancer  Guidelines  Diagnosis  Management  Surgery  Medical  Follow-up  European Association of Urology
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