CCAFU french national guidelines 2016-2018 on renal cancer

The previous guidelines from the Cancer Committee of the Association Française d'Urologie were published in 2013. We wanted this new version to be simple, clear and straightforward. All significant recent publications on kidney cancer have been included. The main changes compared to 2013 are the following: • We added a short section on epidemiology: the prevalence of smoking remains very high in France and we felt that the urologist should warn kidney cancer patients to stop smoking• Some classifications have changed: the WHO classification has been refined in 2016 and Furhman grade has been replaced by the nuclear grade of the International Society of Urological Pathology (ISUP)• Prognostic factors remain clinical and histological; prognostic systems are especially useful in metastatic patients; the IMDC classification is now preferentially used compared to the MSKCC classification• Regarding the treatment of localized kidney cancer: the benefits of partial nephrectomy are clearly established; the robotic access has spread worldwide and was shown to be less morbid than the open access; robotic partial nephrectomy is now recommended on the same level as open partial nephrectomy (that used to be the standard treatment)• The treatment of locally advanced kidney cancer relies on surgery; first adjuvant trials are negative; targeted therapies should only be given through clinical trials• Two molecules (nivolumab and cabozantinib) have shown a survival benefit in phase III trials and have become the standard treatment in second line in patients with metastatic kidney cancer• Finally, follow-up protocols after kidney cancer surgery remain imprecise; large multicentric studies are awaited; meanwhile, follow-up can be adapted according to tumour aggressiveness; low risk tumours rarely recur and the use of X Ray imaging can be less frequent.