In order to clarify factors affecting recurrence, we reviewed 115 renal cell carcinoma patients without distant metastasis at diagnosis (Mo) treated from January 1975 to March 1990 at Sapporo Medical College Hospital. Of these 115 patients, recurrence (metastasis) was found in 23 (20.0%). The non-recurrence rate was 70.6% after the 5-year and 56.5% after the 10-year follow up. In 22 out of 23 patients, recurrence appeared within 3 years following surgery. Multivariate analysis by Cox's proportional hazard model revealed that lymph node metastasis was the most significant factor for recurrence in the 115 patients followed by stage of the primary tumor and pre-operative acute phase reactant (fever, ESR and alpha 2-globulin) in this order. When the analysis was performed in the 88 patients who was in less advanced stage (pN0pV0-1a), pre-operative acute phase reactant (fever, ESR and alpha 2-globulin) was identified as the only significant factor affecting recurrence. This result suggests that pre-operative acute phase reactant is the most important risk factor for recurrence in this group of patients.