Renal Cell Carcinoma (RCC) with regional lymph node involvement represents one of the most challenging scenarios in clinical decision-making, as it lies at the interface between localized and systemic disease. Despite decades of research, the optimal management of patients with node-positive disease remains controversial, largely due to marked heterogeneity in natural history, limitations of current staging methods, and the paucity of high-level evidence supporting specific therapeutic strategies. The European Association of Urology (EAU) Renal Cancer Guidelines Panel has highlighted these uncertainties, emphasizing the need for individualized decision-making in the absence of definitive data [1].