BackgroundLymph node invasion is associated with poor outcome in patients with renal cell carcinoma (RCC).Patients and MethodsPatients with RCC within a single center from 2001 to 2018 were retrospectively obtained from the Chang Gung Research Database. Patient gender, physical status, Charlson Comorbidity Index, tumor side, histology, age at diagnosis, and body mass index (BMI) were compared. The overall survival (OS) and cancer-specific survival (CSS) of each group were estimated using the Kaplan–Meier method. Log-rank tests were used to compare between the subgroups.Results and ConclusionsA total of 335 patients were enrolled, of whom 76 had pT3N0M0, 29 had pT1–3N1M0, 104 had T1–4N0M1, and 126 had T1–4N1M1disease. Significant OS difference was noted between pT3N0M0and pT1–3N1M0groups with 12.08 years [95% confidence interval (CI), 8.33–15.84] versus 2.58 years (95% CI, 1.32–3.85), respectively (P< 0.005). No significant difference was observed in OS between pT1–3N1M0and T1–4N0M1groups with 2.58 years (95% CI, 1.32–3.85) versus 2.50 years (95% CI, 1.85–3.15,P= 0.72). The OS of N1M1group was worse than that of N0M1group with 1.00 year (95% CI, 0.74–1.26) versus 2.50 years (95% CI, 1.85–3.15,P< 0.05). Similar results were also observed in CSS. In summary, we claim that RCC with lymph node (LN) invasion should be reclassified as stage IV disease in terms of survival outcome.