尽管免疫检查点抑制剂与酪氨酸激酶抑制剂的应用推动了围术期辅助治疗策略的发展，局部进展期肾细胞癌（RCC）的新辅助和术后辅助治疗迄今仍处于探索阶段。Ⅱ期临床研究表明，新辅助治疗可以降低手术难度，但目前的Ⅲ期研究尚未证实其能有效降低复发风险或带来持续的生存获益。在术后辅助治疗方面，只有KEYNOTE-564研究确立帕博利珠单抗一年辅助方案在总生存方面的优势，成为迄今唯一获指南强推荐的策略。多项随机对照临床研究未达到预期效果，可能与终点设置与评估工具的敏感性不足、外科质量差异以及肿瘤生物学异质性等因素有关。未来的研究应聚焦于精准人群分层、优化复合终点以及建立标准化手术质控体系，同时整合分子亚群与免疫标志物进行分层，在多学科协作的框架下构建个体化的围术期治疗模式，实现从经验导向向证据与生物学双驱动的转变，以提升局部进展期RCC的整体治疗效果。

The introduction of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) has advanced perioperative systemic strategies, however, the roles of neoadjuvant and adjuvant therapy in locally advanced renal cell carcinoma (RCC) are still being explored. Phase II studies indicate that neoadjuvant therapy can reduce surgical complexity, but existing phase III trials have not confirmed reductions in recurrence risk or durable survival gains. In the adjuvant setting, only KEYNOTE-564 has established a one-year pembrolizumab regimen with an overall survival benefit, making it the sole guideline-endorsed strategy to date. The underperformance of multiple randomized controlled trials likely reflects suboptimal endpoint selection and limited sensitivity of assessment tools, along with variability in surgical quality and intrinsic tumor heterogeneity. Future research should focus on refined patient stratification, optimization of composite endpoints, and standardized surgical quality assurance, while integrating molecular subtypes and immune biomarker–based stratification within a multidisciplinary framework. Such efforts aim to build a personalized perioperative treatment paradigm, shift the field from empiricism to a biologically and evidence-driven model, and ultimately improve outcomes for locally advanced RCC.