摘要肾细胞癌约占成人恶性肿瘤的2%～3%，世界范围内男女患者发病比例约为1.5∶1，各年龄段均可发病，60～70岁为高发年龄段，发病中位年龄约为64岁。目前肾癌的病因尚未明确，吸烟、肥胖、高血压以及一些遗传因素均为肾癌发病的危险因素。尽管随着体检筛查的逐步普及，越来越多的肾癌患者在早期就被发现并接受治疗，然而仍然有约30%的患者在首次诊断时就已是局部进展期或转移性肾癌。传统化疗药物对晚期肾癌基本无效，难以满足临床需求，目前晚期肾癌以抗血管和免疫治疗为主。一线治疗目前多依据国际转移性肾细胞癌数据库联盟预后风险等临床特征进行分层治疗，有抗血管治疗、抗血管联合免疫治疗、双免等多个治疗方案供选择，而后线治疗多根据一线治疗方案组成、有效性和安全性进行药物选择。近年来研究显示，肾癌的分子分型以及转移特征等也影响患者的预后，导致晚期肾癌的治疗存在诸多争议。共识以晚期肾癌管理中尚存争议的临床问题为导向，经多学科临床专家讨论投票后，达成10个临床问题的专家共识。同时，专家推荐国内临床及科研机构主导或参与更多大型临床试验，为临床决策及最佳获益人群的选择提供更多依据。

abstractsRenal cell carcinoma (RCC) accounts for approximately 2% to 3% of malignant tumors in adults, with a male-to-female ratio of approximately 1.5∶1 worldwide. It can occur in all age groups, with a peak incidence in the 60-70 age range, and the median age is approximately 64 years. The current causes of kidney cancer are still unclear, but smoking, obesity, hypertension, and some genetic factors are considered risk factors for kidney cancer development. Conducive to the gradual popularization of physical examination and screening, more and more patients with kidney cancer are being detected and treated in the early stages. However, nearly 30% of patients still have locally advanced or metastatic kidney cancer at the time of initial diagnosis. Traditional chemotherapy drugs are generally ineffective for advanced RCC, and currently, advanced RCC is mainly treated with anti-vascular and immunotherapy. At present, first-line treatment is mostly stratified based on clinical characteristics such as International mRCC Database Consortium (IMDC) prognosis risk, and there are multiple options available, including anti vascular therapy, anti-vascular combined immunotherapy, and dual immunotherapy. Subsequently, first-line treatment often selects drugs based on the composition, effectiveness, and safety of first-line treatment plans. In recent years, research has found that the molecular typing and metastasis characteristics of RCC also affect the prognosis of patients, leading to many controversies in the treatment of advanced RCC. This consensus is guided by the controversial clinical issues in the management of advanced RCC. After discussion and voting by multidisciplinary clinical experts, a consensus of 10 clinical issues has been reached. At the same time, experts recommend domestic clinical and research institutions to lead or participate in more large-scale clinical trials, providing more basis for clinical decision-making and the selection of the best beneficiaries.