European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update

Börje Ljungberg* (Corresponding Author), 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

921 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)799-810
Number of pages12
JournalEuropean Urology
Issue number5
Early online date23 Feb 2019
Publication statusPublished - May 2019

Bibliographical note

Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.


  • Diagnosis
  • European Association of Urology
  • Follow-up
  • Guidelines
  • Management
  • Medical
  • Renal cell cancer
  • Surgery


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