Dagher J, et al. - This examination investigated the effect of tumor associated necrosis (TAN) on metastasis-free survival for clear cell renal cell carcinoma (ccRCC) as well as whether TAN provides survival information in addition to World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading by analyzing data from 376 cases of ccRCC treated by nephrectomy that had available follow-up information. Results of this study suggested that TAN is an important prognostic factor for ccRCC, independent of WHO/ISUP grade. For those with grades 2 - 4 tumors, TAN had a significantly worse prognosis vs those without TAN. TAN could be incorporated into tumor grading criteria.