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Observational Study
. 2020 Feb:136:162-168.
doi: 10.1016/j.urology.2019.09.044. Epub 2019 Nov 6.

UK Multicenter Prospective Evaluation of the Leibovich Score in Localized Renal Cell Carcinoma: Performance has Altered Over Time

Naveen S Vasudev  1 , Michelle Hutchinson  2 , Sebastian Trainor  2 , Roisean Ferguson  2 , Selina Bhattarai  3 , Adebanji Adeyoju  4 , Jon Cartledge  5 , Michael Kimuli  5 , Shibendra Datta  6 , Damian Hanbury  7 , David Hrouda  8 , Grenville Oades  9 , Poulam Patel  10 , Naeem Soomro  11 , Grant D Stewart  12 , Mark Sullivan  13 , Jeff Webster  14 , Michael Messenger  2 , Peter J Selby  2 , Rosamonde E Banks  2
Affiliations
Observational Study

UK Multicenter Prospective Evaluation of the Leibovich Score in Localized Renal Cell Carcinoma: Performance has Altered Over Time

Naveen S Vasudev et al. Urology. 2020 Feb.

Abstract

Objective: To examine changes in outcome by the Leibovich score using contemporary and historic cohorts of patients presenting with renal cell carcinoma (RCC) PATIENTS AND METHODS: Prospective observational multicenter cohort study, recruiting patients with suspected newly diagnosed RCC. A historical cohort of patients was examined for comparison. Metastasis-free survival (MFS) formed the primary outcome measure. Model discrimination and calibration were evaluated using Cox proportional hazard regression and the Kaplan-Meier method. Overall performance of the Leibovich model was assessed by estimating explained variation.

Results: Seven hundred and six patients were recruited between 2011 and 2014 and RCC confirmed in 608 (86%) patients. Application of the Leibovich score to patients with localized clear cell RCC in this contemporary cohort demonstrated good model discrimination (c-index = 0.77) but suboptimal calibration, with improved MFS for intermediate- and high-risk patients (5-year MFS 85% and 50%, respectively) compared to the original Leibovich cohort (74% and 31%) and a historic (1998-2006) UK cohort (76% and 37%). The proportion of variation in outcome explained by the model is low and has declined over time (28% historic vs 22% contemporary UK cohort).

Conclusion: Prognostic models are widely employed in patients with localized RCC to guide surveillance intensity and clinical trial selection. However, the majority of the variation in outcome remains unexplained by the Leibovich model and, over time, MFS rates among intermediate- and high-risk classified patients have altered. These findings are likely to have implications for all such models used in this setting.

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Figures

Figure 1
Figure 1
Metastasis-free survival by Leibovich risk group. Survival curves are shown for patients in the contemporary UK cohort, a comparative historical UK cohort and the original US cohort as reported by Leibovich et al.
See this image and copyright information in PMC

Comment in

  • EDITORIAL COMMENT.
    Russo P. Russo P. Urology. 2020 Feb;136:167-168. doi: 10.1016/j.urology.2019.09.045. Urology. 2020. PMID: 32033668 No abstract available.

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