Simple Urine Test Could Help Patients Avoid Invasive Scans for Kidney Cancer

Clear cell renal cell carcinoma (ccRCC) is the most prevalent type of kidney cancer, making up approximately 90% of cases. Each year, around 400,000 individuals are diagnosed with ccRCC globally. About 20% of ccRCC patients who undergo surgery to remove their cancer will experience a recurrence within five years, with the majority of these relapses occurring within the first two years. At present, the primary method for monitoring patients is through periodic scans, typically CT scans, performed every 6 to 12 months, depending on the patient's risk level. However, a new urine test offers the potential to detect the recurrence of kidney cancer at an early stage, potentially eliminating the need for invasive scans and providing patients with faster access to treatment.

This test works by analyzing the unique profiles of specific sugar molecules known as glycosaminoglycans (GAGs), which are present in urine. These profiles make up the GAGome. The AURORAX-0087A (AUR87A) study, led by Lund University (Lund, Sweden), is investigating whether the GAGome test can accurately detect the return of ccRCC after surgery. The initial cohort of the study included 134 patients treated across 23 hospitals in the UK, EU, USA, and Canada. All patients had ccRCC that was confined to the kidney and treated with surgery, most commonly through a complete kidney removal. Following surgery, patients continued standard CT scan monitoring and also underwent a urine test every three months. Each urine sample was analyzed using mass spectrometry, generating a GAGome score out of 100.

After a follow-up period of up to 18 months, 15% of the patients experienced a recurrence of their cancer. The GAGome test showed high sensitivity in detecting recurrence, accurately identifying 90% of patients whose cancer had returned, while correctly ruling out just over half of those who remained cancer-free. These results were derived from a GAGome score threshold optimized at 12/100, where a score above 12 was considered positive and a score of 12 or below as negative. A positive result from the test indicated a 26% likelihood that the patient had a recurrence. In contrast, a negative GAGome score provided a highly reliable 97% chance that the patient was cancer-free. The higher the GAGome score, the more likely the positive result was an accurate reflection of cancer recurrence. According to the researchers, this level of accuracy rivals that of CT scans and offers several benefits over relying on scans alone.

“CT scans often pick up small lesions that aren’t large enough to biopsy, and we currently don’t know whether they are a sign of the cancer returning or not. Our only option is to do more frequent scans to monitor more closely, which is unpleasant for patients and often brings little benefit,” said lead researcher on the study, Saeed Dabestani, Associate Professor at Lund University. “If you have a urine test that can accurately show whether the cancer has actually returned then you can better assess risk levels and reduce the frequency of the scans required. Based on the results we have so far, it’s likely that we could safely halve the number of scans that patients have to undergo.”

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