Ninety-one consecutive patients with renal cell carcinoma stages pT(1-4)/N(0-3)/V(0-2)/Mo were analyzed for survival rates. The overall 5-year survival was 57%. Factors which made an impact on 5-year survival rates were: (1) grade of anaplasia (GI: 72%, GII: 42%, GUI: 22%; p = 0.0001); (2) pathological stage (pT^: 86%, pT(3): 30%; p = 0.0000); (3) perinephric fat invasion (pT(1-2): 86%, pT(3a): 61%; p = 0.01); (4) nodal involvement (N(0): 69%, N(1): 11 %; p = 0.0000), and (5) venous invasion (Vo: 72%, V(1-2): 30%; p 0.05). Using multivariate statistical analysis we found that grade of anaplasia and venous invasion contained dire prognostic information (p = 0.0000). Among patients with stage pT(3b), those without perinephric fat invasion or nodal involvement had a better survival rate than those with capsular infiltration (p 0.05). Patients with venous invasion developed distant métastasés with a significantly higher frequency than those without (p = 0.01). The prognostic impact of venous invasion is unclear yet, but is probably related to perinephric fat invasion and nodal involvement. Until further data are collected, the radical approach with complete removal of the thrombus remains the treatment of choice for localized renal cell carcinoma with vena cavai extension. Immunotherapy would be expected as complementary treatment in the presence of perinephric fat invasion and/or nodal involvement.