(UroToday.com) Management of patients with localized or locally advanced renal cell carcinoma (RCC) involves surgical resection. However, 20-40% of all localized kidney cancer patients experience a recurrence. Adjuvant treatment in high-risk kidney cancer has not proven to successfully improve overall survival and the only drug approved so far in this setting is vascular endothelial growth factor (VEGF) inhibitor, sunitinib based on a modest disease-free survival benefit.1 As multiple trials are evaluating drugs including immune checkpoint inhibitors in patients with high risk localized clear cell RCC, there is an urgent need to identify biomarkers to help with therapeutic decisions as well as for risk stratification. At the 2021 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU), Dr. Shuchi Gulati and colleagues presented results of their analysis pertaining to genes involved in metabolic reprogramming in kidney cancer. The aim of the study was to analyze metabolic signatures in primary tumors from patients that remain disease free versus those that recur within 24 months of surgery.