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Lookup NU author(s): Professor Naeem Soomro
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2019 The AuthorsObjective: 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.
Author(s): Vasudev NS, Hutchinson M, Trainor S, Ferguson R, Bhattarai S, Adeyoju A, Cartledge J, Kimuli M, Datta S, Hanbury D, Hrouda D, Oades G, Patel P, Soomro N, Stewart GD, Sullivan M, Webster J, Messenger M, Selby PJ, Banks RE
Publication type: Article
Publication status: Published
Journal: Urology
Year: 2020
Volume: 136
Pages: 162-168
Print publication date: 01/02/2020
Online publication date: 06/11/2019
Acceptance date: 13/09/2019
Date deposited: 07/01/2020
ISSN (print): 0090-4295
ISSN (electronic): 1527-9995
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.urology.2019.09.044
DOI: 10.1016/j.urology.2019.09.044
PubMed id: 31705948
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