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Background Surgical resection is the most effective treatment for renal cell carcinoma (RCC).Currently several prognostic factors and models are used for outcome prediction.However,whether intratumoral changes are independent prognostic factors for RCC or not remains unclear.The aim of the study was to investigate the prognostic roles of intratumoral changes in surgical treated localized clear cell renal cell carcinoma (ccRCC).Methods Patients who received partial or radical nephrectomy between 2004 and 2009 in our center were retrospectively reviewed.Univariate and multivariate analyses were used to assess gender,age,body mass index (BMI),intratumoral hemorrhage,tumor necrosis,cystic degeneration,sarcomatoid change,Ki-67 expression,Fuhrman grade,and T stage on recurrence-free survival (RFS) and cancer-specific survival (CSS).Results A total of 378 patients were included in our study.In univariate analysis,age,BMI,intratumoral hemorrhage,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade,and T stage were prognostic factors for RFS.Age,BMI,tumor necrosis,sarcomatoid change,Ki-67 expression level,Fuhrman grade,and T stage were prognostic factors effecting CSS.In multivariate analysis,age,BMI,tumor necrosis,sarcomatoid change,Ki-67,Fuhrman grade,and T stage were independent prognostic factors for both RFS and CSS.Conclusion Intratumoral changes such as tumor necrosis and sarcomatoid change are independent prognostic factors for ccRCC.