免疫肿瘤学策略正在彻底改变几种肿瘤类型的围手术期治疗。肾细胞癌 (RCC) 的围手术期环境是一个不断发展的领域，免疫疗法的出现正在产生重大进展。 批判性地回顾 RCC 中基于免疫的辅助和新辅助治疗策略的潜在利弊，并为肾细胞癌提供见解该领域的未来研究。我们对现有文献进行了合作性叙述性回顾。派姆单抗辅助免疫治疗是肾切除术后复发风险较高患者的新护理标准，证明了无病生存和总生存获益第三阶段 KEYNOTE-564 试验。目前的数据不支持在临床试验之外使用新辅助治疗。虽然基于免疫的佐剂和新佐剂方法都是由强大的生物学原理驱动的，但新佐剂免疫疗法可能会产生更强、更持久的抗肿瘤免疫反应。如果新辅助单药免疫检查点抑制剂对原发肿瘤的活性有限，基于免疫的组合可能会显示出活性增强。对于仅通过手术治愈的患者来说，过度治疗和相关毒性风险是新辅助和辅助策略的常见问题。肾细胞癌缺乏有助于患者选择和治疗去强化的生物标志物。目前还没有比较新辅助或围手术期免疫治疗与辅助免疫治疗的随机试验结果。辅助免疫治疗是肾细胞癌的新护理标准。新辅助和辅助免疫治疗策略都有潜在的优点和缺点。优化围手术期治疗策略是微妙的，基于新辅助免疫疗法的作用尚待确定。鉴于术前/围术期方法具有强有力的生物学原理，需要进行前瞻性临床试验来确定临床疗效。需要研究有助于患者选择和治疗去强化策略的生物标志物。免疫疗法正在改变肾癌的治疗。在这篇综述中，我们研究了肾癌患者手术前和/或术后免疫治疗策略的研究，以评估潜在的利弊。我们的结论是，新辅助和辅助免疫治疗策略可能都有潜在的优点和缺点。虽然手术后进行的免疫治疗已经是一种标准治疗，但在未来的研究中应该更好地研究手术前的免疫治疗。未来的试验还应侧重于患者的选择，以避免仅通过手术治愈的患者出现毒性。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

Immune-oncology strategies are revolutionising the perioperative treatment in several tumour types. The perioperative setting of renal cell carcinoma (RCC) is an evolving field, and the advent of immunotherapy is producing significant advances.To critically review the potential pros and cons of adjuvant and neoadjuvant immune-based therapeutic strategies in RCC, and to provide insights for future research in this field.We performed a collaborative narrative review of the existing literature.Adjuvant immunotherapy with pembrolizumab is a new standard of care for patients at a higher risk of recurrence after nephrectomy, demonstrating a disease-free survival and overall survival benefit in the phase 3 KEYNOTE-564 trial. Current data do not support neoadjuvant therapy use outside clinical trials. While both adjuvant and neoadjuvant immune-based approaches are driven by robust biological rationale, neoadjuvant immunotherapy may enable a stronger and more durable antitumour immune response. If neoadjuvant single-agent immune checkpoint inhibitors demonstrated limited activity on the primary tumour, immune-based combinations may show increased activity. Overtreatment and a risk of relevant toxicity for patients who are cured by surgery alone are common concerns for both neoadjuvant and adjuvant strategies. Biomarkers helping patient selection and treatment deintensification are lacking in RCC. No results from randomised trials comparing neoadjuvant or perioperative immune-based therapy with adjuvant immunotherapy are available.Adjuvant immunotherapy is a new standard of care in RCC. Both neoadjuvant and adjuvant immunotherapy strategies have potential advantages and disadvantages. Optimising perioperative treatment strategies is nuanced, with the role of neoadjuvant immune-based therapies yet to be defined. Given strong biological rationale for a pre/perioperative approach, there is a need for prospective clinical trials to determine clinical efficacy. Research investigating biomarkers aiding patient selection and treatment deintensification strategies is needed.Immunotherapy is transforming the treatment of kidney cancer. In this review, we looked at the studies investigating immunotherapy strategies before and/or after surgery for patients with kidney cancer to assess potential pros and cons. We concluded that both neoadjuvant and adjuvant immunotherapy strategies may have potential advantages and disadvantages. While immunotherapy administered after surgery is already a standard of care, immunotherapy before surgery should be better investigated in future studies. Future trials should also focus on the selection of patients in order to spare toxicity for patients who will be cured by surgery alone.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.