The value of a postoperative nomogram based on the primary tumor score for overall survival of patients with renal cell carcinoma and inferior vena cava tumor thrombus

•Regarding the controversy over the prognostic value of the primary tumor, our study supports that the level of IVCTT and tumor size have no significant prognostic value.•For patients with RCC and IVCTT, the primary tumor score demonstrates promise in reflecting the prognostic value of local lesions.•the model we proposed can accurately predicted OS with C-index of 0.77 and the AUC of time-dependent ROC for 1, 2, and 3year OS were 0.80, 0.81, and 0.78.•For patients in high-risk group classified by our model, postoperative adjuvant therapy significantly improved the survival(P = 0.02) compared to low-risk group(P = 0.42). Radical surgery can achieve remarkable improvements in the survival of patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT); however, not all patients can obtain the desired results. Therefore, identifying patients with poor survival after surgery is crucial for guiding follow-up adjuvant therapies and patient counseling. To evaluate the impact of primary tumor score based on tumor necrosis and tumor thrombus morphology on overall survival (OS), and create a postoperative prognostic model for patients with RCC and IVCTT. This retrospective study included 182 patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy (RNTE). Preoperative contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), ultrasound imaging, and clinical records were collected. Kaplan-Meier analysis was used to evaluate the overall survival (OS). Prognostic factors for OS were identified by univariate and multivariate analyses using the Cox proportional hazards regression model. A nomogram was developed and internally calibrated using the bootstrap resampling method. The mean follow-up time was 24.1 months (1–84.5 months), and 34.1% (62 of 182) of the patients died of all causes. The primary tumor score possesses a superior prognostic value for the primary tumor compared with the level of IVCTT and tumor size. Multivariate Cox regression analysis showed that primary tumor score, distant metastasis, nonclear cell subtype, sarcomatoid degeneration, preoperative anemia grade, and ASA level were independent prognostic factors. Based on these factors, a nomogram was built; the concordance index was 0.77, and the AUC for predicting 1–3 years OS were 0.80, 0.81, and 0.78, respectively. Primary tumor score is a independent prognostic factors for patients with RCC and IVCTT. Combined with 5 easily acquir