[French ccAFU guidelines - update 2020-2022: management of kidney cancer]
K Bensalah1, P Bigot1, L Albiges1
1Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France.
Objective:
- To update the French guidelines on kidney cancer.
Methods:
- A systematic review of the literature between 2015 and 2020 was performed. The most relevant articles regarding the diagnosis, the classification, surgical treatment, medical treatment and follow-up of kidney cancer were retrieved and included in the new guidelines. The guidelines were updated with corresponding levels of evidence.
Results:
- Thoraco-abdominal CT scan with injection is the best radiological exam for the diagnosis of kidney cancer. MRI and contrast ultra-sound can be useful in some cases. Percutaneous biopsy is recommended when histological results will affect clinical decision. Renal tumours must be classified according to pTNM 2017 classification and ISUP grade. Metastatic kidney cancers must be classified according to IMDC criteria. Partial nephrectomy is the recommended treatment for T1a tumours and can be done through an open, laparoscopic or robotic access. T1b tumours can be treated by partial or total nephrectomy according to tumour complexity. Radical nephrectomy is the recommended treatment of advanced localized tumours. There is no recommended adjuvant treatment. In metastatic patients: cyto-reductive nephrectomy can be offered in case of good prognosis; medical treatment must be counseled first in case of intermediate or bad prognosis. Surgical or local treatment of metastases should be considered in case of solitary lesion or oligo-metastases. First line recommended drugs in metastatic patients include the associations axitinib/pembrolizumab and nivolumab/ipilimumab. Cystic tumours must be classified according to Bosniak Classification. Surgical excision should be offered to patients with Bosniak III and IV lesions. It is recommended to follow patients clinically and with imaging according to tumour aggressiveness.
Conclusion:
- These updated recommendations should assist French speaking urologists for their management of kidney cancers.
Insights
Updated French guidelines for kidney cancer management emphasize CT scans for diagnosis and partial nephrectomy for T1a tumors. They detail classification, metastatic treatment with targeted therapies, and follow-up strategies for improved patient care.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Kidney cancer diagnosis and treatment require updated clinical guidelines.
- Recent advancements necessitate a review of current management strategies.
Purpose of the Study:
- To update the French guidelines for kidney cancer management.
- Incorporate recent literature (2015-2020) into clinical recommendations.
Main Methods:
- Systematic literature review (2015-2020).
- Inclusion of articles on diagnosis, classification, surgical and medical treatment, and follow-up.
- Updated guidelines with evidence levels.
Main Results:
- Thoraco-abdominal CT with contrast is the preferred diagnostic imaging.
- Partial nephrectomy is recommended for T1a tumors; radical nephrectomy for advanced localized disease.
- First-line metastatic treatment includes axitinib/pembrolizumab or nivolumab/ipilimumab.
Conclusions:
- These updated guidelines provide a framework for French-speaking urologists.
- Recommendations cover diagnosis, staging, treatment, and follow-up of kidney cancers.
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