Is active surveillance an option for metachronous metastatic renal cell carcinoma?

About 30% of patients treated with partial or radical nephrectomy for localized renal cell carcinoma (RCC) develop nodal or distant metastases during the follow-up (1). According to the time of recurrence, relapses are classified into early or late if occurring before or after 5 years from surgery (2). Early recurrences seem to be associated with a worse prognosis in comparison with late ones (3,4). Indeed, risk stratification according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) currently represents the most relevant prognosticator for patients with metastatic renal cell carcinoma (mRCC) (5).