Renal cell carcinoma (RCC) represents an increasing global oncological burden, with substantial geographic variation in clinicopathological characteristics, stage at presentation, and treatment outcomes. While contemporary management increasingly incorporates nephron-sparing and minimally invasive approaches, data from surgically treated RCC cohorts in low- and middle-income settings remain limited. This study aimed to evaluate the clinicopathological profile, stage distribution, surgical management patterns, and survival outcomes of RCC patients undergoing nephrectomy at a tertiary oncology centre in India.

A retrospective analysis was performed on 98 patients with histologically confirmed RCC who underwent nephrectomy over a 10-year period. Demographic variables, clinical presentation, histopathological characteristics, surgical approach, and follow-up data were collected. Overall survival (OS) was estimated using the Kaplan–Meier method. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards regression analysis.

The median age at diagnosis was 58.5 years with a male predominance (male:female ratio 1.4:1). Most patients presented with symptomatic disease, while only 21% of tumors were detected incidentally. Radical nephrectomy was the most common surgical procedure. Clear cell RCC was the predominant histological subtype (79.6%). Stage distribution included Stage I (16.3%), Stage II (38.7%), Stage III (31.6%), and Stage IV (13.3%). After a median follow-up of 51.5 months, the median OS was 40 months and the overall 5-year survival rate was 64.3%. Advanced TNM stage, metastatic disease, and inferior vena cava thrombosis were independent predictors of poorer survival on multivariate analysis.

This nephrectomy-based series demonstrates a younger age at presentation and a higher proportion of advanced-stage disease compared with Western populations. Despite this, acceptable stage-adjusted survival outcomes were observed following surgical management. Strengthening early detection and referral pathways may improve outcomes in the Indian setting.