肾细胞癌(RCC)是第三常见泌尿生殖系统恶性肿瘤，2020年全球死亡人数达到约18万。尽管超过三分之二的患者最初呈现局部病变，但其中高达50%的患者可能发展为转移性疾病。辅助治疗旨在降低多种癌症复发风险并改善预后，但目前在RCC中尚未满足需求。酪氨酸激酶抑制剂在转移性RCC中取得的结果导致对这些靶向治疗在早期应用于RCC中的评估，围绕无疾病生存期的结果存在冲突，整体生存期(OS)没有益处。同样，免疫检查点抑制剂(ICIs)在辅助治疗中的结果也存在冲突。虽然可用数据未显示ICIs在早期阶段有OS改善，但记录了Pembrolizumab的积极趋势，在此应用中获得了美国食品和药物管理局的批准。但是，几种ICIs的令人失望的结果和RCC的不均匀模式需要鉴定生物标记和亚组分析，以评估哪些患者可以从辅助治疗中获益。在本评述中，我们将讨论RCC的辅助治疗理念，总结最重要的辅助治疗试验和当前应用，以概述可能的未来方向。

Renal cell carcinoma (RCC) is the third most common genitourinary cancer accounting for approximately 180,000 deaths worldwide in 2020. Although over two-thirds of patients initially present localized disease, up to 50% of them may progress to metastatic disease. Adjuvant therapy aims to reduce the recurrence risk and improve outcomes in several types of cancers but is currently an unmet need in RCC. The results achieved with tyrosine kinase inhibitors in metastatic RCC led to the evaluation of these target therapies in an early setting with conflicting results for disease-free survival and no overall survival (OS) benefit. Likewise, the results of immune checkpoint inhibitors (ICIs) in an adjuvant setting are conflicting. Available data did not show an improvement in OS with ICIs in the early phase, although a positive trend for pembrolizumab has been recorded, receiving the Food and Drug Administration's approval in this setting. However, the disappointing results of several ICIs and the heterogeneous pattern of RCC warrant biomarker identification and subgroup analyses to evaluate which patients could benefit from adjuvant therapy. In this review, we will discuss the rationale for adjuvant treatment in RCC, summarizing the results of the most important adjuvant therapy trials and current applications, to outline possible future directions.