Elsevier

European Urology

Volume 67, Issue 5, May 2015, Pages 913-924
European Urology

Guidelines
EAU Guidelines on Renal Cell Carcinoma: 2014 Update

https://doi.org/10.1016/j.eururo.2015.01.005Get rights and content

Abstract

Context

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

Objectives

To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable.

Evidence acquisition

For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment.

Evidence synthesis

All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

Conclusions

The 2014 guideline has been updated by a multidisciplinary panel using the highest methodological standards, and provides the best and most reliable contemporary evidence base for RCC management.

Patient summary

The European Association of Urology Guideline Panel for Renal Cell Carcinoma has thoroughly evaluated available research data on kidney cancer to establish international standards for the care of kidney cancer patients.

Introduction

The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel has compiled these clinical guidelines to provide clinicians with evidence-based information and recommendations for the management of patients with RCC. The RCC panel is an international group consisting of clinicians with particular expertise in this field. To meet the requirements for a multidisciplinary approach, the panel has recently been reinforced by several experts, including a medical oncologist, pathologists, radiologists, a methodologist, biostatisticians, and members of patient advocacy groups. The EAU RCC guidelines were first published in 2000 [1], with a subsequent full update in 2006 and partial updates in 2007, 2008, 2009, 2010 [2], and 2013. The current 2014 document presents a full-text update and is fundamentally different from the versions published previously. The panel adopted Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [3] in undertaking systematic reviews (SRs) in 2011 to ensure that the evidence synthesis was performed in a robust, standardised, transparent, and reproducible manner. For the 2014 update, the panel has proceeded with the SR work in a stepwise fashion. The majority of sections have been updated based on SRs; however, a few sections of the document have been updated following a structured literature assessment, as shown in Table 1. As a result, the previous guideline has been completely revised and supplemented with a section on management of venous tumour thrombus. A detailed version of the current guideline including full references, level of evidence, and grade of recommendations is available at www.uroweb.org [4]. The focus for the next 2 yr is for the complete guidelines document to be based on SRs for evidence synthesis, as SRs represent the highest possible level of data work-up.

Section snippets

Evidence acquisition

All chapters of the 2014 RCC Guidelines publication have been updated. As mentioned in Table 1, the consistency of the data work-up differed between sections. For the parts of the guideline that have been updated by SR, the review methodology is outlined in detail in several ensuing publications [5], [6]. In brief, SRs of the literature were conducted in accordance with PRISMA guidelines [3]. Important topics and questions were prioritised by the panel for the present update. For each SR,

Evidence synthesis

The majority of the studies included in this guideline update are retrospective analyses that include some larger multicentre studies and well-designed controlled studies. As only a few RCTs are available, most of the data are not based on high levels of evidence. The exception was for systemic treatment of metastatic RCC (mRCC), for which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

Conclusions

These updated 2014 guidelines provide the current evidence base for the management of RCC according to the most robust and reliable standards. In contrast to previous versions, a multidisciplinary panel prioritised the importance of specific topics and questions, for which evidence synthesis was performed based on SRs. In addition, guideline recommendations were graded according to the 2009 Oxford Centre for Evidence-based Medicine Levels of Evidence. The aim of the panel is to strengthen the

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