(UroToday.com) Up to 40% of patients with localized renal cell carcinoma (RCC) will develop metastatic disease and unfortunately, adjuvant therapy trials to date have failed to demonstrate an overall survival benefit. Transcriptomic profiling of the RCC tumor microenvironment has revealed gene signatures predictive of response to therapies in the metastatic setting, as high expression of angiogenesis genes correlate with responses to tyrosine kinase inhibitors. Additionally, adenosine in the tumor microenvironment exerts immunosuppressive effects that can facilitate tumor growth. Adenosinergic agonism has revealed gene signatures, comprised of inflammatory myeloid mediators, that correlated with response to adenosine pathway inhibition on a previously reported cohort of patients. Given these promising data from the metastatic space, Dr. Phillip Rappold and colleagues sought to interrogate prognostic gene expression in the tumor microenvironment from patients with localized disease, results of which were presented at the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU).