RISING ERYTHROCYTE SEDIMENTATION-RATE DURING SEVERAL YEARS BEFORE DIAGNOSIS CAN BE A PREDICTIVE FACTOR IN 70-PERCENT OF RENAL-CELL CARCINOMA PATIENTS - THE BENEFIT OF KNOWING SUBJECT-BASED REFERENCE VALUES

Objectives. A diagnosis of renal cell carcinoma (RCC) early enough for potentially curative surgery is difficult. We wanted to establish whe ther the erythrocyte sedimentation rate (ESR) in RCC patients had begu n to rise before the appearance of any symptoms or signs and, if so, w hen. Design, A retrospective study of the evolution of the ESR in 236 randomly selected RCC patients during several years before diagnosis, comparing the results with previously obtained population-based contro l values, Results. It is generally held that RCC patients have a high ESR at diagnosis. In our material, however, 29.7% of the RCC cases had an ESR that at this time was at or below the population-based upper r eference limit; it had not increased significantly, neither with time before diagnosis, nor with age. In 70.3% of RCC patients the ESR was i ncreased and had been significantly rising for up to 6 years or more b efore diagnosis. This had not been adequately responded to, probably b ecause the physicians lacked knowledge of the patients' baseline ESR, and because none of the prediagnostic readings had been above the popu lation-based reference limit. Conclusions, Systematic ESR graphic reco rdings over time will enable a physician to determine each individual' s baseline value, and hence note any continuously rising trend, which should lead to further investigations, e.g. an ultrasound kidney exami nation. This may provide an early clue to many otherwise non-symptomat ic RCC cases. It is time for a reappraisal of the predictive value of the ESR to discover early RCC, and possibly other diseases as well.