Renal Cell Carcinoma

2. METHODS

2.1. Data identification

For the 2024 RCC Guidelines, new and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature. A broad and comprehensive scoping exercise covering all areas of the RCC Guidelines was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 24th, 2022 and May 1st, 2023. Databases covered included Medline, EMBASE, and the Cochrane Library. After de-duplication, a total of 1,901 unique records were identified, retrieved and screened for relevance. A search strategy is published online: https://uroweb.org/guidelines/renal-cell-carcinoma/publications-appendices.

Recommendation within the Guidelines are developed by the panels to prioritise clinically important care decisions. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and the nature and variability of patient values and preferences. This decision process, which can be reviewed in the strength rating forms which accompany each guideline statement, addresses a number of key elements:

1. the overall quality of the evidence which exists for the recommendation [1];
2. the magnitude of the effect (individual or combined effects);
3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
4. the balance between desirable and undesirable outcomes;
5. the impact and certainty of patient values and preferences on the intervention.

Strong recommendations typically indicate a high degree of evidence quality and/or a favourable balance of benefit to harm and patient preference. Weak recommendations typically indicate availability of lower quality evidence, and/or equivocal balance between benefit and harm, and uncertainty or variability of patient preference [2].

Additional methodology information and a list of associations endorsing the EAU Guidelines can be found in the online: https://uroweb.org/eau-guidelines/methodology-policies.

2.2. Review

All publications ensuing from systematic reviews (SR)s have been peer reviewed. The 2021 print of the RCC Guidelines was peer-reviewed prior to publication.

2.3. Future goals

The RCC Guideline Panel supports the focus on patient-reported outcomes as well as the development of clinical quality indicators. A number of key quality indicators for this patient group have been selected:

• the proportion of patients undergoing thorax computed tomography (CT) for staging of pulmonary metastasis;
• proportion of patients with T1aN0M0 tumours undergoing nephron-sparing surgery (NSS) as first treatment;
• the proportion of patients with metastatic RCC (mRCC) offered systemic therapy;
• the proportion of patients who undergo minimally invasive or operative treatment as first treatment who die within 30 days.

The Panel have set up a database to investigate current practice in follow-up of RCC patients in a number of European centres. Assessing patterns of recurrence and use of imaging techniques are primary outcomes for this project.

In addition, the Panel will collect data from various European datasets on atypical recurrences following minimally invasive renal surgery to establish incidence and insight on potential causes, their management and outcome.

Further, a registry for Bosniak IV cysts with single nodularity will be established to investigate if diameter of the cyst or nodule is leading in clinical management.

The results of ongoing and new systematic reviews will be included in future updates of the RCC Guidelines:

• Systematic review of prevalence of intraperitoneal recurrences following robotic/laparoscopic partial nephrectomy;
• Systematic review of individual, unit and hospital surgical volume for radical and partial nephrectomy and their impact on outcomes;
• RECUR database analysis of recurrent disease/follow-up;
• Systematic review on management of oligometastatic and oligoprogressive disease.