435 Background: Renal cell carcinoma (RCC) venous extension is a challenging condition. Its prognostic significance is not well established. We investigated possible prognostic correlations between venous extension in RCC, with its various levels, and local extension, lymphatic spread and systemic metastasis; and its impact on progression free survival (PFS) and overall survival (OS). Methods: We analyzed an IRB-approved prospectively-maintained kidney cancer database at Roswell Park Cancer Institute. Patients with venous involvement were identified, classified according to the highest cephalic venous thrombus extension into 3 groups; group 1, renal vein; group 2, infrahepatic; group 3, subdiaphragmatic. Preoperative, postoperative, and pathologic factors were recorded. Patient characteristics were compared between groups using Kruskal-Wallis and Chi-Square tests for quantitative and categorical variables respectively. Results: 711 patients underwent nephrectomy for RCC between 2004 and 2011. Out of 63 patients with RCC and venous tumor thrombus, 55 patients were analyzed in this study who underwent radical nephrectomy and venous thrombectomy. Median age was 63 years and median follow-up was 18.7 months. 37 patients were group 1, 10 were group 2, and 8 were group 3. 1 and 3 year PFS were 66% and 38.5% respectively, and 1 and 3 year OS were 74.2% and 47.4% respectively. There were no statistically significant differences in OS or PFS between different groups. Among several factors examined, venous extension was associated with increased risk of distant metastasis, and that risk did not increase with higher cephalic venous extension (p = 0.011). When patients were categorized by local extension and nodal disease spread, there was no statistically significant association with venous tumor extension (p =0.24 and 0.35 respectively), though they were independently associated with distant spread (p = 0.002 and 0.013 respectively) and OS (p =0.005 and0.03 respectively). Conclusions: Venous tumor extension alone can serve as an independent predictor of distant metastasis in patients with RCC. Our analysis suggests that cephalic venous thrombus extension does not impact patient survival.