Objective To examine the usefulness of serum immuno-122 patients, N1-3 in seven, M0 in 114 patients and M1 in 19. The area of the ROC curve for tumour size suppressive acidic protein (IAP) as a predictor for staging renal cell carcinoma (RCC), using receiverwas greatest (0.843) for staging of the local extent (T1/T2 versus T3/T4) and that for IAP was 0.714, operator characteristic (ROC) analysis, and to compare IAP with other tumour markers. similar to the values for fibrinogen, ESR and CRP. For predicting lymph node metastasis, IAP and fibrinogen Patients and methods From September 1983 to December 1995, serum IAP was measured in 133 were the most important (0.864). However, IAP alone (0.894) was the most important predictor of distant untreated patients with RCC (mean age 60.1 years, sd 11.4, range 31-84). The erythrocyte sedimentation metastasis. Using an IAP threshold of 600 mg/mL gave a high sensitivity and specificity for detecting lymph rate (ESR), the levels of fibrinogen, C-reactive protein (CRP), and a2-globulin were also measured. To comnode and distant metastasis. Conclusion IAP is a valuable predictor of lymph node pare these markers as predictors of local involvement of the renal capsule, lymph node and distant metastaand distant metastasis in patients with RCC, although it is inferior to tumour size in predicting local involvesis, the area under the corresponding ROC curve was calculated. Tumour size at the time of resection was ment of the renal capsule. The appropriate threshold value of IAP for detecting lymph node and distant added in this analysis for comparison with the levels of these tumour markers.metastasis is 600 mg/mL.