This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
Worst prognosis in renal cell carcinoma is assocaited with - 
Select and explain. 
A. Haematuria, B. Size>5cm, C. Invasion of renal vein, D. Pulmonary secondaries
D: Pulmonary secondaries
Answer: D: Pulmonary secondaries 
Explanation: None