Advancing renal cell carcinoma care Multidisciplinary strategies from diagnosis to follow-up

This thesis evaluates key decision points in the management of renal cell carcinoma (RCC) to support more patient-centred and evidence-based care. RCC is increasingly detected incidentally, and its variable clinical course makes treatment decisions complex.
The findings show that multidisciplinary collaboration contributes to consistent and guideline-based care. Within the Amsterdam renal cancer network, multidisciplinary tumour board recommendations were followed in 96% of cases, and multiple treatment options were often proposed, especially for cT1a tumours, supporting shared decision making. Renal tumour biopsy showed high diagnostic accuracy and was associated with fewer benign findings after surgery, indicating that selective use may reduce overtreatment. Nevertheless, nationwide data showed that 12% of partial nephrectomies for suspected cT1 RCC still resulted in benign pathology.
For cT1b RCC, partial and radical nephrectomy achieved similar long-term oncological outcomes, while partial nephrectomy provided better preservation of renal function but more complications. In metastatic RCC, deferred cytoreductive nephrectomy after response to ipilimumab-nivolumab may be valuable in selected patients. Finally, the reviewed evidence suggests that more intensive CT follow-up than recommended by EAU guidelines is unlikely to improve survival after curative treatment for non-metastatic RCC. Overall, this thesis supports a personalized approach to RCC care based on multidisciplinary evaluation, selective diagnostics, and shared decision making.