肾癌2023.v1（英文）-NCCN肿瘤临床实践指南

NCCNClinicalPracticeGuidelinesinOncologyNCCNGuidelines®)KidneyCancerersionJuneNCCNGuidelinesforPatients®availableat/patientsVersion1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.*RobertJ.Motzer,MD/Chair†Þ*EricJonasch,MD/Vice-chair†TheUniversityofTexasNeerajAgarwal,MD‡†AjjaiAlva,MBBS†UniversityofMichiganRogelCancerCenterMichaelBaine,MD,PhD§Fred&PamelaBuffetCancerCenterKathrynBeckermann,MD,PhD†Vanderbilt-IngramCancerCenterMariaI.Carlo,MD†ToniK.Choueiri,MD†ÞCancerCenter|MassachusettsGeneralHospitalCancerCenterBrianA.Costello,MD,MS†IthaarH.Derweesh,MDωcerCenterArpitaDesai,MD†ÞUCSFHelenDillerFamilyCenterYasserGed,MBBS†hensiveCancersSabyGeorge,MD†RoswellParkComprehensiveCancerCenteresPanelDisclosuresJohnL.Gore,MD,MSωSeattleCancerCareAllianceNaomiHaas,MD†nterStevenL.Hancock,MD§ÞPayalKapur,MD≠CenterChristosKyriakopoulos,MD‡UniversityofWisconsinCarboneCancerCenterElaineT.Lam,MD†UniversityofColoradoCancerCenterPrimoN.Lara,MD†UCDavisComprehensiveCancerCenterClaytonLau,MDωCityofHopeNationalMedicalCenterDavidC.Madoff,MD∩YaleCancerCenter/SmilowCancerHospitalBrandonManley,MDωMoffittCancerCenterM.DrorMichaelson,MD,PhD†CancerCenter|MassachusettsGeneralHospitalCancerCenterAmirMortazavi,MD†eCancerCenterJamesCancerHospitalLakshminarayananNandagopal,MD†O'NealComprehensiveCancerCenteratUABElizabethR.Plimack,MD,MS†ÞFoxChaseCancerCenterLeePonsky,MDωhensiveCancerCenterSundharRamalingam,MD†BrianShuch,MDωCLAJonssonComprehensiveCancerCenterZacharyL.Smith,MDωSitemanCancerCenteratBarnes-JewishHospitalandWashingtonUniversitySchoolofMedicineJeffreySosman,MD‡garwalPhDiPhDchonfeldBA†Medicaloncology¥Patientadvocacy§Radiotherapy/Radiationoncology*DiscussionwritingcommitteememberanelMembersyoftheGuidelinesUpdateslowUpforStageIIIIKIDanelMembersyoftheGuidelinesUpdateslowUpforStageIIIIKIDKIDeatmentKIDgeryKIDABSystemicTherapyforRelapseorStageIVDiseaseKIDCCarcinomaCriteriaforFurtherGeneticRiskEvaluationforHereditaryRCCSyndromes(HRCC-1)HereditaryRCCSyndromesOverview(HRCC-2)GeneticTesting(GENE-1)Kidney-SpecificScreeningRecommendationsforPatientswithConfirmedHereditaryRCC(HRCC-B)Kidney-SpecificSurgicalRecommendationsforPatientswithConfirmedHereditaryRCC(HRCC-C)Kidney-SpecificSystemicTherapyforPatientswithConfirmedHereditaryRCC(HRCC-D)Abbreviations(ABBR-1)dexlievesthatthebestmanagementforanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.FindanNCCNMemberInstitution:/home/member-institutions.fEvidenceanddationsotherwisedNCategoriesofEvidenceandConsensus.NCCNCategoriesofPreference:Allrecommendationsareconsideredappropriate.SeeNCCNCategoriesofPreference.TheNCCNGuidelinesareastatementofevidenceandconsensusoftheauthorsregardingtheirviewsofcurrentlyacceptedapproachestotreatmentAnyclinicianseekingtoapplyorconsulttheNCCNGuidelinesisexpectedtouseindependentmedicaljudgmentinthecontextofindividualstancestodetermineanypatientscareortreatmentTheNationalComprehensiveCancerNetworkNCCNmakesnorepresentationsorwarrantiesofanykindregardingtheircontentuseorapplicationanddisclaimsanyresponsibilityfortheirapplicationoruseinanywayTheNCCNbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.©2022.Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexsionoftheNCCNGuidelinesforKidneyCancerfromVersioninclude•AdjuvantTreatmentpPathway2revised:"Clinicaltrial"removed.pBottompathway◊Clearcellhistologyrevised:"Clinicaltrial(preferred)"removed.◊Non-clearcellhistologyrevised:Surveillanceorclinicaltrial•TreatmentforRelapseorStageIVpClearcellhistology◊4thlinerevised:"...MetastasectomyorSBRTorablativetechniquesforoligometastaticdiseaseorMetastasectomywithcompleteresectionofdisease,followedbyadjuvantpembrolizumabwithin1yearofnephrectomy."•DiseaseProgressionforRelapseorStageIVpClearcellhistology◊Bottomlineadded:"...BestsupportivecareorMetastasectomyorSBRTorablativetechniquesforoligometastaticdisease."(AlsoforNon-clearcellhistology)•PrinciplesofSurgerypBullet6,sub-bullet3revised:AblativetechniquesareassociatedwithahigherlocalrecurrenceratethanconventionalsurgeryandmayrequiremultipletreatmentstoachievethesamelocaloncologicoutcomesasconventionalsurgeryKID-C(1of2)•PrinciplesofSystemicTherapyforRelapseorStageIVDiseasepSubsequentTherapyforClearCellHistology◊PreferredRegimens–Lenvatinib+everolimuswaschangedtoacategory2Arecommendation.◊OtherRecommendedRegimens–Tivozanibwaschangedtoacategory1recommendation.◊UsefulinCertainCircumstances–Belzutifanwasaddedasacategory2Brecommendation.Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESUPDATESVersion1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexsionoftheNCCNGuidelinesforKidneyCancerfromVersionincludeKID-C(2of2)•SystemicTherapyforNon-ClearCellHistologypOtherRecommendedRegimens◊Nivolumab+cabozantinibwasaddedasacategory2Arecommendation.pUsefulinCertainCircumstances◊Nivolumab+ipilimumabwasaddedasacategory2Brecommendation.•Footnotehrevised:Forcollectingductormedullarysubtypes,partialresponseshavebeenobservedwithcytotoxicchemotherapy(carboplatin+gemcitabine,carboplatin+paclitaxel,orcisplatin+gemcitabine)andotherplatinum-basedchemotherapiescurrentlyusedforurothelialcarcinomas.Gemcitabine+doxorubicincanalsoproduceresponsesinrenalmedullarycarcinoma(RMC)(WilsonNR,etal.ClinGenitourinCancer2021;(6)19:e401-e408RoubaudG,etal.Oncology2011;80:214-218;ShahAY,etal.BJUInt2017;120:782-792).Oraltargetedtherapiesgenerallydonotproduceresponsesinpatientswithrenalmedullarycarcinoma(RMC);erlotinib+bevacizumabcanproduceresponseseveninheavilypretreatedpatientswithRMC.Outsideofclinicaltrials,platinum-basedchemotherapyregimensshouldbethepreferredfirst-linetherapyforrenalmedullarycarcinomaRMC.•CriteriaforFurtherGeneticRiskEvaluationforHereditaryRCCSyndromespBullet2revised:AnindividualwithRCCoranindividualunaffectedwithanyofthefollowingcriteriapColumn2,bottompathwayrevised:"...Refertospecificsyndromes-SeeHereditaryRCCSyndromesOverview(HRCC-2),SeeNCCNGuidelinesforGenetic/FamilialHigh-RiskAssessment:Breast,Ovarian,andPancreatic:PrinciplesofCancerRiskAssessmentandCounseling(EVAL-A)andPedigree(EVAL-B)"spFootnotecadded:Ifunaffected,whenpossible,testfamilymemberwithhighestlikelihoodofapathogenic/likelypathogenicvariantbeforetestinganunaffectedindividual.pFootnotedadded:UnnecessaryintranslocationalRCCormedullaryRCC.•Footnote4added:BelzutifanisFDA-approvedforthetreatmentofVHL-associatedRCC,centralnervoussystem(CNS)hemangioblastomas,orpNETnotrequiringimmediatesurgery.•Footnote5added:JonaschE,DonskovF,IliopoulosO,etal.BelzutifanforRenalCellCarcinomainvonHippel–LindauDisease.NEnglJMed2021;385:2036-2046.ABBR-1•Newsectionadded:AbbreviationsultiplerenalonsidergeneticevaluationSeeereditaryRenalCellCarcinomasHRCC1)urothelialcarcinomaPrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.NotapprovedultiplerenalonsidergeneticevaluationSeeereditaryRenalCellCarcinomasHRCC1)urothelialcarcinomadexusINITIALWORKUPHP•CBCwithdifferential,comprehensivemetabolicpanel,LDHbdominalbdominalpelvicCTa•CTchesta•CTchesta(preferred)orchestx-ray•IfclinicallyindicatedpConsidercoreneedleebbiopsy(ebsuspected(eg,centralmass),considerurinecytology,ureteroscopyorPRIMARYTREATMENTd,eADJUVANTTPRIMARYTREATMENTd,eADJUVANTTREATMENTSTAGEFOLLOW-UPg(CATEGORY2B)orAblativetechniquesActivesurveillanceveillanceveillancefRadicalnephrectomy(inselectpatients)PartialnephrectomyRadicalnephrectomyorActivesurveillance(inselectpatients)D(Grade4tumorswithclearSeeKID-BistologyistologysarcomatoidStageIIaturesorRadicalnephrectomyveillanceflhistologyveillanceflhistologyAdjuvantpembrolizumabStageIIIorveillancefAdjuvantsunitinib(category3)Adjuvantsunitinib(category3)yallyindicatedStageIVSeeaImagingwithandwithoutcontrastisstronglypreferred,suchasarenalprotocol.bBiopsyofsmalllesionsmaybeconsideredtoobtainorconfirmadiagnosisofmalignancyandguidesurveillanceorablativetechniques,cryosurgery,andradiofrequencyablationstrategies.cIfmetastaticdiseaseispresentorthepatientcannottolerateureteroscopy.dSeePrinciplesofSurgery(KID-A).eStereotacticbodyradiotherapy(SBRT)maybeconsideredformedicallyinoperablepatientswithStageIkidneycancer(category2B)orwithStageII/IIIkidneycancer(bothcategory3).fSeeFollow-up(KID-B).gNosinglefollow-upplanisappropriateforallpatients.Follow-upshouldbeindividualizedbasedonpatientrequirements.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.KID-1Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexSTAGEPRIMARYTREATMENTdresectableprimaryhsamplingPotentiallysurgicallyresectableprimaryhsamplingentsCytoreductivenephrectomySeeKID-entsSystemictherapy(SeeKID-3)(preferredinclearcellhistologywithpoor-riskfeatures)StageIVSurgicallyunresectablehTissuesamplingSeeKID-3dSeePrinciplesofSurgery(KID-A).hIndividualizetreatmentbasedonsymptomsandextentofmetastaticdisease.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.KID-2Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexSIONClinicaltrialorSeeFirst-LineTherapy(KID-C,1of2)orMetastasectomyorSBRTorablativetechniquesforoligometastaticdiseaseorMetastasectomywithcompleteresectionofdisease,followedbyadjuvantpembrolizumabwithin1yearofnephrectomyststsupportivecareiFollow-upSeeKID-BClinicaltrialorSeeSubsequentTherapyforClearCellHistology(KID-C,1of2)ststsupportivecareiorMetastasectomyorSBRTorablativetechniquesforoligometastaticdiseaseNon-clearcellhistologyClinicaltrial(preferred)orSeeSystemicTherapy(KID-C,2of2)orstsupportivecareiMetastasectomyorSBRTorablativetechniquesforstsupportivecareiFollow-upSeeKID-BClinicaltrialorSeeSystemicTherapyforNon-ClearCellHistology(KID-C,2of2)ststsupportivecareiorMetastasectomyorSBRTorablativetechniquesforoligometastaticdiseaseBestsupportivecarecanincludepalliativeRTbisphosphonatesorRANKligandinhibitorsforbonymetastasesNote:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.KID-3PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexPRINCIPLESOFSURGERY•Nephron-sparingsurgery(partialnephrectomy)isappropriateinselectedpatients,forexample:pUnilateralstageI–IIItumorswheretechnicallyfeasiblepUninephricstate,renalinsufficiency,bilateralrenalmasses,andfamilialrenalcellcancerpPatientsatrelativeriskfordevelopingprogressivechronickidneydiseaseduetoyoungageormedicalriskfactors(ie,hypertension,diabetes,nephrolithiasis)Openlaparoscopicorroboticsurgicaltechniquesmaybeusedtoperformradicalandpartialnephrectomies.Regionallymphnodedissectionisoptionalbutisrecommendedforpatientswithresectableadenopathyonpreoperativeimagingorpalpable/visibleadenopathyattimeofsurgery.•Ifadrenalglandisuninvolved,adrenalectomymaybeomitted.Specialteamsorreferraltohigh-volumecentersmayberequiredforextensiveinferiorvenacavainvolvement.•Thermalablation(eg,cryosurgery,radiofrequencyablation)isanoptionforthemanagementofpatientswithclinicalstageT1renallesions.pThermalablationisanoptionformasses<3cm,butmayalsobeanoptionforlargermassesinselectpatients.Ablationinmasses>3cmisassociatedwithhigherratesoflocalrecurrence/persistenceandcomplications.pBiopsyofsmalllesionsconfirmsadiagnosisofmalignancyforogicoutcomesasconventionalsurgeryabsurveillance,cryosurgery,andradiofrequencyablationstrategies.pogicoutcomesasconventionalsurgeryab•ActivesurveillanceisanoptionfortheinitialmanagementofpatientswithclinicalstageT1renallesions,forexample:pPatientswithsmallrenalmasses<2cmgiventhehighratesofbenigntumorsandlowmetastaticpotentialofthesemasses.pActivesurveillanceofpatientswithT1atumors(≤4cm)thathaveapredominantlycysticcomponentisrecommended.pPatientswithclinicalstageT1massesandsignificantcompetingrisksofdeathormorbidityfromintervention.pActivesurveillanceentailsserialabdominalimagingwithtimelyinterventionshouldthemassdemonstratechanges(eg,increasingtumorsize,growthrate,infiltrativepattern)indicativeofincreasingmetastaticpotential.pActivesurveillanceshouldincludeperiodicmetastaticsurveyincludingbloodworkandchestimaging,particularlyifthemassdemonstratesgrowth.•Generally,patientswhowouldbecandidatesforcytoreductivenephrectomypriortosystemictherapyhave:pExcellentperformancestatus(ECOGPS<2)pNobrainmetastasisaCampbellS,UzzoR,AllafM,etal.Renalmassandlocalizedrenalcancer:AUAGuideline.JUrol2017;198:520-529.bPierorazioP,JohnsonM,PatelH,etal.Managementofrenalmassesandlocalizedrenalcancer:Systematicreviewandmeta-analysis.JUrol2016;196:989-999.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.KID-AVersion1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.KID-BOF5PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsKID-BOF5dexFOLLOW-UPa,byBStageI(T1a)Follow-upDuringActiveSurveillancec•H&Pannually•Laboratorytestsannually,asclinicallyindicated•Abdominalimaging:pAbdominalCTorMRIwithcontrastifnocontraindicationwithin6moofsurveillanceinitiation,thenCT,MRI,orultrasound(US)atleastannually•Chestimaging:pChestx-rayorCTatbaselineandannuallyasclinicallyindicatedtoassessforpulmonarymetastases•Considerrenalmassbiopsyatinitiationofactivesurveillanceoratfollow-up,asclinicallyindicated•Follow-upmaybeindividualizedbasedonsurgicalstatus,treatmentschedules,sideeffects,comorbidities,andsymptomsFollow-upAfterAblativeTechniquesc•H&Pannually•Laboratorytestsannually,asclinicallyindicated•Abdominalimaging:pAbdominalCTorMRIwithandwithoutIVcontrastat1–6mofollowingablativetherapyunlessotherwisecontraindicated,thenCTorMRI(preferred),orUSannuallyfor5yorlongerasclinicallyindicated.IfpatientisunabletoreceiveIVcontrast,MRIisthepreferredimagingmodalitypIfthereisimagingorclinicalconcernsforrecurrence,thenmorefrequentimaging,renalmassbiopsy,orfurthertreatmentmaybeindicated•Chestimaging:pChestx-rayorCTannuallyfor5yforpatientswhohavebiopsy-provenlow-riskrenalcellcarcinoma(RCC),nondiagnosticbiopsies,ornopriorbiopsyaDonatSM,DiazM,BishoffJT,etal.Follow-upforclinicallylocalizedrenalneoplasms:AUAGuideline.JUrol2013;190:407-416.bNosinglefollow-upplanisappropriateforallpatients.Follow-upfrequencyanddurationshouldbeindividualizedbasedonpatientrequirements,andmaybeextendedbeyond5years(SeeKID-B,5of5).Furtherstudyisrequiredtodefineoptimalfollow-upduration.cImagingwithcontrastwhenclinicallyindicated.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexFOLLOW-UPa,byBStageI(pT1a)and(pT1b)cFollow-upAfteraPartialorRadicalNephrectomy•H&Pannually•Laboratorytestsannually,asclinicallyindicated•Abdominalimaging:pBaselineabdominalCTorMRI(preferred),orUSwithin3–12moofsurgery,thenannuallyfor3yorlongerasclinicallyindicatedpAmorerigorousimagingscheduleortechniquemodalitycanbeconsideredifpositivemarginsoradversepathologicfeatures(suchassarcomatoid,high-grade[grade3/4])•Chestimaging:pChestx-rayorCTannuallyforatleast5y,thenasclinicallyindicatedpAmorerigorousimagingscheduleortechniquemodalitycanbeconsideredifpositivemarginsoradversepathologicfeaturesaDonatSM,DiazM,BishoffJT,etal.Follow-upforclinicallylocalizedrenalneoplasms:AUAGuideline.JUrol2013;190:407-416.bNosinglefollow-upplanisappropriateforallpatients.Follow-upfrequencyanddurationshouldbeindividualizedbasedonpatientrequirements,andmaybeextendedbeyond5years(SeeKID-B,5of5).Furtherstudyisrequiredtodefineoptimalfollow-upduration.cImagingwithcontrastwhenclinicallyindicated.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.KID-B2OF5PrintedbyMinTangon6/19/202210:53:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexFOLLOW-UPa,byBFollow-upforStageIIorIII•H&Pevery3–6mofor3y,thenannuallyupto5y,andasclinicallyindicatedthereafter•Comprehensivemetabolicpanelandothertestsasindicatedevery3–6mofor3y,thenannuallyupto5y,andasclinicallyindicatedthereafter•Abdominalimaging:pBaselineabdominalCTorMRIwithin3–6mo,thenCTorMRI(preferred),orUS(USiscategory2BforstageIII),every3–6moforatleast3yandthenannuallyupto5ypImagingbeyond5y:asclinicallyindicated•Chestimaging:pBaselinechestCTwithin3–6mowithcontinuedimaging(CTpreferred)every3–6moforatleast3yandthenannuallyupto5ypImagingbeyond5y:asclinicallyindicatedbasedonindividualpatientcharacteristicsandtumorriskfactors•Additionalimaging(ie,bonescan,brainimaging):pAssymptomswarrantaDonatSM,DiazM,BishoffJT,etal.Follow-upforclinicallylocalizedrenalneoplasms:AUAGuideline.JUrol2013;190:407-416.bNosinglefollow-upplanisappropriateforallpatients.Follow-upfrequencyanddurationshouldbeindividualizedbasedonpatientrequirements,andmaybeextendedbeyond5years(SeeKID-B,5of5).Furtherstudyisrequiredtodefineoptimalfollow-upduration.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version1.2023,06/17/22©2022NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenper