\received DD MMMM YYYY \acceptedDD MMMM YYYY Background:About 10% renal cell carcinoma (RCC) patients presented with venous tumor thrombus (VTT) at diagnosis and surgery is the current standard treatment for them. However, there lacks a prognostic model in clinic for these patients after surgery treatment. In this study, we aimed to identify the prognostic factors for RCC patients with VTT after surgery treatment and incorporated them into a predictive nomogram. Methods: Cases of RCC patients with VTT were retrieved from Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier survival curve was established to depict survival probabilities over time and the log-rank test was used to compare the differences. Propensity score matching (PSM) was used to balance the bias of baseline characteristics between groups. Univariate and multivariate Cox regression analysis were performed to identify prognosis related characteristics. The independent factors were incorporated into the nomogram development for overall survival (OS) prediction. The Harrell’s concordance index (C-index), calibration curve, receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to evaluate the performance and clinical utility of the developed nomogram model. Results: We retrieved 11,926 patients of RCC with VTT, 10,213 (85.64%) of them received surgery (surgery group) and the other 1,713 (14.36%) patients were managed non-operatively (no-surgery group). After PSM, OS in surgery group was significantly better than no-surgery group (P<0.001). We identified prognostic indicators and developed a predictive nomogram. The C-index was 0.739 in the training set, 0.749 and 0.739 in the validation set and TCGA validation set respectively. The net benefit of our nomogram was higher than the default strategies across a wide range of practical threshold probabilities. Conclusions: Surgery can significantly improve the prognosis of RCC patients with VTT. A nomogram for OS prediction in RCC patients with VTT after surgery treatment was developed and showed relatively good discrimination and calibration.