Which patients with renal cell carcinoma should be considered for adjuvant therapy after nephrectomy?

Patients with renal cell carcinoma (RCC) who should be considered for adjuvant therapy following nephrectomy are those at high risk of recurrence, particularly with locally advanced disease features such as pT3 or higher stage, node-positive disease, or high-grade tumours. This recommendation aligns with UK clinical practice guidelines that emphasize risk stratification post-nephrectomy to identify candidates for adjuvant treatment NICE NG2.

Specifically, adjuvant therapy with agents like sunitinib has been studied and shown to provide benefit in patients with high-risk RCC, as demonstrated in the S-TRAC trial, which included patients with high-risk features such as tumour stage ≥pT3 and/or node-positive disease Staehler et al. 2018. This trial supports offering adjuvant sunitinib to reduce recurrence risk in this subgroup.

Further, recent literature highlights the evolving landscape of post-nephrectomy management, suggesting that biological factors such as sarcomatoid differentiation and molecular risk profiles may refine patient selection for adjuvant therapy Ciccarese et al. 2023Salgia et al. 2025. However, these are emerging considerations and currently complement rather than replace established clinical risk criteria.

In summary, patients with high-risk pathological features after nephrectomy—such as pT3 or higher stage, nodal involvement, or high-grade tumours—should be considered for adjuvant therapy to reduce recurrence risk, with sunitinib being a validated option supported by clinical trial evidence.