Urinary hyaluronic acid is a Wilms' tumor marker

Abstract

Wilms' tumor is a renal neoplasm that is histologically similar to fetal kidney tissue. Both Wilms' tumor and the fetal kidney have high levels of the glycosaminoglycan hyaluronic acid (HA) in the extracellular matrix. Preliminary studies suggest that urinary HA levels are elevated in Wilms' tumor patients. To test the utility of urinary HA as a Wilms' tumor marker, the authors compared HA levels in urine specimens from 105 Wilms' tumor patients with those of 17 agematched controls. Preoperative urine samples (n = 92), early postoperative samples, obtained from 1 to 3 weeks after surgery (n = 63), and late postoperative samples, obtained from 1 to 6 months after surgery (n = 58) were collected from patients at 30 institutions between 1989 and 1993. The HA levels were determined in triplicate by a competitive enzymelinked immunosorbent binding assay. Seventy-four percent of the preoperative urine specimens contained elevated HA levels compared with the controls. The preoperative HA levels were significantly higher than the early postoperative ( P < .01), late postoperative ( P < .01), and control levels ( P < .01). There was significant correlation between preoperative HA levels and clinical tumor staging. The mean preoperative HA level for patients with histological evidence of nephroblastomatosis was higher than that for patients without nephroblastomatosis. In the late postoperative period, patients with relapse or persistent disease had higher levels of urinary HA than did the disease-free patients ( P < .05). In Wilms' tumor patients, urinary HA levels are elevated preoperatively and decline progressively after surgery. Elevated late postoperative HA levels may indicate tumor relapse or persistence. Thus, urinary HA measurement can aid in the diagnosis and management of patients with Wilms' tumor.