Introduction and Context
Neoadjuvant therapy — treatment given before surgery — is increasingly used to downstage tumors, improve resectability, and test systemic agents in the pre‑operative window. In several cancers (breast, rectal, bladder), the degree of pathological response after neoadjuvant therapy (for example, the proportion of residual viable tumor or a pathological complete response) is an accepted surrogate of treatment efficacy and can predict outcome. Until now, renal cell carcinoma (RCC) has lacked an international, standard approach for how to prepare nephrectomy specimens and how to measure and report pathological response after pre‑operative systemic therapy.
In a systematic review and consensus effort published by the International Neoadjuvant Kidney Cancer Consortium (INKCC) led by Blackmur et al. (Lancet Oncology, 2025), investigators reviewed the reporting practices for neoadjuvant RCC and produced practical, consensus recommendations to standardize tissue handling and reporting in trials and research settings. The guideline responds to several clinical gaps: heterogeneous reporting in the literature, inconsistent sampling that limits reproducibility, and lack of agreed definitions for what constitutes a meaningful pathological response in RCC.
