Objective: To investigate B7-H4 expression in stage T1 renal cell carcinoma and its role in evaluation of prognosis. Methods: B7-H4 expression was detected in kidney specimen from 102 cases,whose clinical features and renal cell carcinoma recurrence rate were also recorded. Results: There was no significant difference in the clinical and pathological features between the B7-H4 positive and negative groups;the disease free survival rate and metastasis rate were significantly higher in the B7-H4 positive group than those of the negative group. Tumor size and clinical stage have a significant correlation with the B7-H4 expression in renal cell carcinoma recurrence after surgery(P < 0.05). Conclusion: The B7-H4 expression is closely related to the development and immune evasion of renal clear cell carcinoma,and is valuable in predicting the prognosis of patients with renal cell carcinoma.