French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer.

To update the recommendations for the management of kidney cancers.

A systematic review of the literature was conducted from 2015 to 2022. The most relevant articles on the diagnosis, classification, surgical treatment, medical treatment and follow-up of kidney cancer were selected and incorporated into the recommendations. Therefore, the recommendations were updated while specifying the level of evidence (high or low).

The gold standard for the diagnosis and evaluation of kidney cancer is contrast-enhanced chest and abdominal CT. MRI and contrast-enhanced ultrasound are indicated in special cases. Percutaneous biopsy is recommended in situations where the results will influence the therapeutic decision. Renal tumours should be classified according to the pTNM 2017 classification, the WHO 2022 classification and the ISUP nucleolar grade. Metastatic kidney cancer should be classified according to the IMDC criteria. Partial nephrectomy is the gold standard treatment for T1a tumours and can be performed by an open approach, by laparoscopy or by robot-guidance. Active surveillance of tumours less than 2cm in size can be considered regardless of the patient's age. Ablative therapies and active surveillance are options in elderly patients with comorbidity. T1b tumours should be treated by partial or radical nephrectomy depending on the complexity of the tumour. Radical nephrectomy is the first-line treatment for locally advanced cancers. Adjuvant treatment with pembrolizumab should be considered in patients at intermediate and high risk for recurrence after nephrectomy. In metastatic patients: Immediate cytoreductive nephrectomy may be offered to oligometastatic patients in combination with local treatment of metastases if this can be complete and delayed cytoreductive nephrectomy can be proposed for patients with a complete response or a significant partial response. Medical treatment should be proposed as first-line therapy for patients with a poor or intermediate prognosis. Surgical or local treatment of metastases can be proposed in case of single or oligo-metastases. The recommended first-line drugs for metastatic patients with clear cell renal carcinoma are the combinations axitinib/pembrolizumab, nivolumab/ipililumab, nivolumab/cabozantinib and lenvatinib/pembrolizumab. Cabozantinib is the recommended first-line treatment for patients with metastatic papillary carcinoma. Cystic tumours should be classified according to the Bosniak classification. Surgical removal should be proposed as a priority for Bosniak III and IV lesions. It is recommended that patient monitoring be adapted to the aggressiveness of the tumour.

These updated recommendations are a reference that will allow French and French-speaking practitioners to improve kidney cancer management.

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2022 Nov [Epub]

P Bigot, P Barthelemy, R Boissier, Z-E Khene, C Pettenati, J-C Bernhard, J-M Correas, N Doumerc, P Gimel, A Ingels, F-X Nouhaud, I Ouzaïd, N Rioux-Leclercq, L Albiges, M Rouprêt

Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, Angers University Hospital, Angers, France. Electronic address: ., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology and Kidney Transplantation, Aix-Marseille University, AP-HM, Conception University Hospital, Marseille, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, Rennes University Hospital, Rennes, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, Hôpital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Adult Radiology, Hôpital Necker, AP-HP Centre, Université de Paris, Paris, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, Medipole, Cabestany, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, UPEC, Hôpital Henri-Mondor, Créteil, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, University Hospital of Rouen, Rouen, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, Bichat Claude Bernard Hospital, Paris Cité University, Paris, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Pathology, Rennes University Hospital, Rennes, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of Cancer Medicine, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France., Comité de cancérologie de l'Association française d'urologie, groupe rein, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne University, GRC 5, Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière Hôpital, Paris, France.

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