Editor’s Note: On August 22–23, 2025, the 2025 Pujiang Uro-Oncology Conference was held in Shanghai, bringing together leading experts to discuss advances in urologic oncology. This article is based on the pre-conference session presented by Professor Youyan Guan (Cancer Hospital, Chinese Academy of Medical Sciences) and Professor Xiongjun Ye, titled “Comprehensive Management of Renal Cancer Patients.” Their lecture systematically reviewed the evolution of treatment concepts, perioperative and advanced-stage strategies, and the construction of comprehensive management systems, aiming to provide clinical and research colleagues with valuable reference and guidance. 

Evolution of Treatment Concepts: From Local Therapy to Comprehensive Management

Professor Guan emphasized that, with continuous progress in pharmacologic therapies, surgery, and radiotherapy, the management of malignant tumors is shifting toward a “chronic disease” model. This trend has already been observed in breast cancer, lymphoma, and hepatocellular carcinoma, and urologic malignancies are actively embracing this approachHe explained that the essence of comprehensive management lies in early intervention — from the earliest stage of disease — and in laying out a coordinated strategy that covers the entire disease course. This includes building a standardized management system that ensures patients receive optimal benefit throughout the continuum of care.

Optimizing Strategies for Localized and Locally Advanced RCC

Professor Guan provided a detailed overview of the treatment algorithm for localized or locally advanced RCC:- T1 to some T3 tumors: Surgery remains the primary treatment.- High-risk pathology (T3 or higher): Postoperative adjuvant therapy should be considered to reduce the risk of recurrence.- Hereditary RCC: Management is more complex and may involve deferring conventional surgery in favor of systemic therapy, or adopting individualized treatment plans that combine systemic therapy with nephron-sparing surgery.He stressed that treatment planning for early-stage patients should be more refined, with the goal of maximizing long-term clinical outcomes.

Refined Risk Stratification and First-Line Therapy for Advanced RCC

In the treatment of advanced RCC — especially clear cell RCC — Professor Guan noted that the International Metastatic RCC Database Consortium (IMDC) risk stratification system is now the cornerstone for clinical decision-making, categorizing patients into favorable, intermediate, and poor risk groups to guide standardized therapy.- Favorable-risk patients: TKI monotherapy remains a guideline-recommended first-line option, consistent with real-world practice.- Intermediate- or poor-risk patients: The preferred option is targeted–immunotherapy combination therapy. With the increasing availability of combination regimens, especially domestically developed options, treatment choices for advanced RCC are expanding.

Perioperative Therapy: Adjuvant and Neoadjuvant Immunotherapy

Professor Guan highlighted the standardization of perioperative strategies:Adjuvant therapy: The KEYNOTE-564 trial has provided robust 5-year disease-free survival (DFS) and overall survival (OS) data, making adjuvant immunotherapy widely recommended for high-risk patients (pT3 or higher, or with sarcomatoid features). Clinicians are advised to fully discuss potential adverse events with patients before initiating treatment.Neoadjuvant therapy: Although promising for reducing surgical complexity, OS benefit remains unproven. Studies led by Academician Xu Zhang and others have contributed valuable data, but sample sizes remain small. CACA guidelines acknowledge that OS benefit is not yet confirmed, leaving neoadjuvant therapy as an important focus for future exploration.

Strategic Planning for Second-Line Therapy and Follow-Up Systems

Professor Guan stressed that comprehensive management extends beyond first-line therapy. Second-line treatment after progression — particularly following IO-TKI failure — is a major challenge:- Clinical trial participation is the preferred recommendation.- If trials are not available, alternative combinations or local treatments (surgery, radiotherapy) may be considered.- Progression after TKI monotherapy is generally managed with the addition of immunotherapy.He underscored the importance of robust follow-up systems, especially in lower-tier cities where resources may be limited. Monitoring adverse events is crucial, as timely recognition and management can prevent serious outcomes.

National Initiatives and the Role of Digital Health

Professor Guan noted that the National Health Commission is actively advancing standardized management and quality control metrics for renal, bladder, and prostate cancers. Early evidence from other cancer types shows that comprehensive management frameworks can improve overall outcomes. Ongoing studies are gathering real-world follow-up data on IO-TKI treatment to guide future practice.He emphasized the need for data-sharing platforms, integrated follow-up networks, patient education, caregiver training, and community support systems to maximize patient benefit.

Expert Perspectives and Future Outlook

In closing, Professor Guan stated:

“With overall improvements in RCC treatment and the trend toward chronic disease management of malignancies, establishing and implementing a comprehensive RCC management system is imperative. To achieve this goal, we must continue to refine treatment paradigms — from localized to locally advanced and advanced/metastatic disease — including optimizing perioperative strategies and standardizing first-, second-, and later-line regimens. At the same time, we should harness digital and intelligent technologies to build a national RCC management framework that integrates expert experience with real-world data. This will ensure that patients, regardless of location or treating physician, can receive the best possible care. The advancement of RCC comprehensive management not only expands treatment options but also showcases China’s growing contributions to the global field of urologic oncology.”