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 T3 or higher stage, node-positive disease, or high-grade tumours. This is supported by UK clinical practice which prioritises risk stratification post-nephrectomy to identify candidates for adjuvant treatment to reduce recurrence risk ¹.

Specifically, adjuvant therapy with agents like sunitinib has been studied in patients with high-risk RCC, demonstrating a potential benefit in disease-free survival, as evidenced by the S-TRAC trial focusing on patients with high-risk features such as T3 or T4 tumours or node-positive disease (Staehler et al., 2018).

Recent literature further emphasizes the importance of biological and clinical risk factors, including sarcomatoid differentiation, which may influence the decision for adjuvant therapy due to their association with aggressive disease and higher metastatic potential (Salgia et al., 2025). Additionally, evolving evidence suggests that post-nephrectomy management should be tailored based on comprehensive risk stratification incorporating tumour stage, grade, and molecular characteristics to optimize therapeutic outcomes (Ciccarese et al., 2023).

In summary, patients with high-risk localized RCC—characterized by advanced pathological stage (≥T3), nodal involvement, high tumour grade, or adverse histological features—should be considered for adjuvant therapy following nephrectomy to improve disease-free survival and reduce recurrence risk.