Label-free machine learning detects a multi-cancer signal in a noninvasive urine and plasma metabolite panel: a case control study

Background: Urine and plasma metabolites are attractive noninvasive cancer biomarkers, but most panels are developed and normalized using case-control labels and evaluated only at study prevalence. We assessed how well a four-metabolite panel separates cancer cases from controls across eight cancer types, whether this separation is detectable without outcome labels, and how performance translates to realistic prevalence. Methods: In this exploratory multi-cohort case-control study, we measured creatine riboside, N-acetylneuraminic acid, cortisol sulfate, and a bile-acid glucuronide by targeted

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