Abstract: Objective:To evaluate cytoreductive nephrectomy pre-operative variables for examining their prognostic value in metastat -ic renal cell carcinoma (mRCC) patients with targeted therapy. Methods:This retrospective study reviewed the clinicopathological data of 40patients who underwent cytoreductive nephrectomy surgery followed by targeted therapy within one year in Tianjin Medical Uni-versity Cancer Institute and Hospital between January 1996and June 2015. Kaplan-Meier method was adopted for single factor analy-sis, and Cox regression model was used for multivariate analysis. Results:Univariate analysis showed that alkaline  phosphatase,  plate-let lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), D-dimer, high T stage, a larger number of tumor metastasis organ, and MSKCC high score are significantly correlated with poor overall survival (OS) (P<0. 005 ). Alkaline phosphatase, PLR, NLR, D-dimer, a larg -er number of tumor metastasis organ, and MSKCC high score are significantly correlated with poor progression-free survival (PFS) ( P< 0. 005 ). Multivariate regression analysis showed that D-dimer predicts poor survival outcomes and is an effective independent prognos-tic factor in OS and PFS (P=0. 033 ). Alkaline phosphatase and MSKCC hazard model are independent prognostic factors in PFS (P=0. 045 and P=0. 003 , respectively). Conclusion: Pre-operation D-dimer can be considered as an independent risk factor in mRCC patients with targeted therapy.