**5. Postoperative targeted therapy in patients without metastasis**

For patients with non-metastatic RCC and tumor thrombus, the recurrence rate of the tumor is approximately 50% at 3 years preoperatively, despite performing RN [27]. Thus, for these patients, only operative treatment may not be sufficient. Adjuvant IL-2/IFN applied in prophase postoperatively, chemotherapy, and hormone therapy are all negative for high-recurrence risk RCC [28]. Small molecules targeting the vascular endothelial growth factor pathway prolong the progression-free survival of patients with advanced RCC [29, 30]. Based on these, the postoperative application of antiangiogenic medicine for patients with high-relapse risk RCC will play a positive role. Three randomized controlled trials, currently, have reported the outcomes of adopting targeted therapy for high-recurrence risk RCC. Although a study found that sunitinib treatment 1-year postoperatively prolonged relapse-free survival for 1–2 years. Two other studies did not find a survival benefit [31–33]. Therefore, the European Association of Urological Surgeons does not recommend targeted drugs for postoperative RCC with high risk of relapse [34].

For patients with non-metastatic RCC and tumor thrombus, a cohort study designed by the Chinese PLA General Hospital analyzed the efficacy and safety of the postoperative administration of sorafenib or sunitinib. The results showed that no survival benefit was observed for patients with tumor thrombus or IVC tumor thrombus who were administered postoperative adjuvant sorafenib or sunitinib [19].
