Background: Renal cell carcinoma (RCC) is the seventh most common cancer in the UK. It is necessary to examine recent treatment trends and outcomes in England to understand the evolving landscape. The primary aim was to describe the demographic and clinical characteristics of patients with RCC, and assess their overall survival (OS) and treatment duration, overall and by subgroups of interest. Secondly, we aimed to understand use of systemic therapies over time. Methods: This was a retrospective cohort study of patients diagnosed with RCC during 2014-2018 using national registry, treatment and hospital data in England. Descriptive statistics were explored with Chi-squared, Fishers exact and Wilcoxon rank sum tests. OS and treatment duration were analysed using Cox regression models to provide hazard ratios (HR) with 95% CI. Kaplan Meier curves were used to compare the proportion of patients alive or on treatment. Results: The cohort included 32,577 individuals; median age at diagnosis 67 years; 36.6% of patients were female; 81.4% exhibited clear cell histology. RCC diagnosed at stage I-III appeared to increase from 61% in 2015 to 68% in 2018. A total of 5,657 patients received at least 1 line of systemic treatment, decreasing to 2,606 and 989 patients for 2 and 3 treatment lines; at 3 months, treatment persisted for 59.9%, 19.0% and 20.5% respectively. In the cohort, 25,566 (78.5%, 95% CI: 78.0–78.9) were alive 1 year from the date of diagnosis and 21,856, (67%, 95% CI: 66.6–67.6) were alive at 3 years. In the subgroup with metastatic disease, 6,786 (37.1%, 95% CI: 35.9–38.2) were alive at 1 year which decreased to 18.0% (95% CI: 17.06–18.92) at 3 years. Among patients with metastatic disease at initial diagnosis, OS was reduced in those with non-clear cell compared to clear cell RCC (HR: 1.19 [95% CI 1.07-1.33]), and those without nephrectomy had a lower probability of survival compared with those who did have a nephrectomy (HR: 2.54, 95% CI: 2.34–2.75). Conclusions: This study presents the most recent and extensive RCC data from England, examining treatment duration, overall survival and patient demographics at presentation, by histology, metastatic status and line of therapy subgroups. These findings could facilitate exploration of potential unmet needs, inequities of treatment or risk factors for patients.