Börje Ljungberg1, Laurance Albiges2, Yasmin Abu-Ghanem3, Karim Bensalah4, Saeed Dabestani5, Sergio Fernández-Pello6, Rachel H Giles7, Fabian Hofmann8, Milan Hora9, Markus A Kuczyk10, Teele Kuusk11, Thomas B Lam12, Lorenzo Marconi13, Axel S Merseburger14, Thomas Powles15, Michael Staehler16, Rana Tahbaz17, Alessandro Volpe18, Axel Bex19. 1. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden. Electronic address: borje.ljungberg@umu.se. 2. Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France. 3. Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. 4. Department of Urology, University of Rennes, Rennes, France. 5. Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden. 6. Department of Urology, Cabueñes University Hospital, Gijón, Spain. 7. Department of Nephrology and Hypertension, Patient Advocate International Kidney Cancer Coalition (IKCC), University Medical Center Utrecht, Utrecht, The Netherlands. 8. Department of Urology, Sunderby Hospital, Sunderby, Sweden. 9. Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic. 10. Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany. 11. Department of Urology, Royal Free Hospital, Pond Street, London, UK. 12. Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. 13. Department of Urology, Coimbra University Hospital, Coimbra, Portugal. 14. Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany. 15. The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK. 16. Department of Urology, Ludwig-Maximilians University, Munich, Germany. 17. Department of Urology, University Hospital Hamburg Eppendorf, Hamburg, Germany. 18. Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy. 19. The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Abstract
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.
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 cancerpatients.
Authors: Q Tang; R C Lin; L Yao; Z Zhang; H Hao; C J Zhang; L Cai; X S Li; Z S He; L Q Zhou Journal: Beijing Da Xue Xue Bao Yi Xue Ban Date: 2019-08-18