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

Vasudev, Naveen S.; Hutchinson, Michelle; Trainor, Sebastian; Ferguson, Roisean; Bhattarai, Selina; Adeyoju, Adebanji; Cartledge, Jon; Kimuli, Michael; Datta, Shibendra; Hanbury, Damian; Hrouda, David; Oades, Grenville; Patel, Poulam; Soomro, Naeem; Stewart, Grant D.; Sullivan, Mark; Webster, Jeff; Messenger, Michael; Selby, Peter J.; Banks, Rosamonde E.

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


Authors

Naveen S. Vasudev

Michelle Hutchinson

Sebastian Trainor

Roisean Ferguson

Selina Bhattarai

Adebanji Adeyoju

Jon Cartledge

Michael Kimuli

Shibendra Datta

Damian Hanbury

David Hrouda

Grenville Oades

POULAM PATEL POULAM.PATEL@NOTTINGHAM.AC.UK
Professor of Clinical Oncology

Naeem Soomro

Grant D. Stewart

Mark Sullivan

Jeff Webster

Michael Messenger

Peter J. Selby

Rosamonde E. Banks



Abstract

© 2019 The Authors 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.

Journal Article Type Article
Acceptance Date Sep 13, 2019
Online Publication Date Nov 6, 2019
Publication Date 2019-11
Deposit Date Dec 12, 2019
Publicly Available Date Dec 12, 2019
Journal Urology
Print ISSN 0090-4295
Publisher Elsevier
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1016/j.urology.2019.09.044
Keywords Urology
Public URL https://nottingham-repository.worktribe.com/output/3540930
Publisher URL https://www.sciencedirect.com/science/article/pii/S0090429519309483

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