UK multicentre prospective evaluation of the Leibovich score in localised renal cell carcinoma: performance has altered over time.

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 multi-centre 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.

706 patients were recruited between 2011-2014 and RCC confirmed in 608 (86%) patients. Application of the Leibovich score to patients with localised 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 versus 22% contemporary UK cohort).

Prognostic models are widely employed in patients with localised 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 amongst intermediate- and high-risk classified patients have altered. These findings are likely to have implications for all such models used in this setting.

Urology. 2019 Nov 06 [Epub ahead of print]

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, Naeem Soomro, Grant D Stewart, Mark Sullivan, Jeff Webster, Michael Messenger, Peter J Selby, Rosamonde E Banks

Leeds Institute of Medical Research at St James's, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Electronic address: ., Leeds Institute of Medical Research at St James's, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK., Department of Pathology, St James's University Hospital, Leeds, LS9 7TF., Stockport NHS Foundation Trust, Stockport, UK., Department of Urology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK., University Hospital of Wales, Cardiff Heath Park, Cardiff, Wales CF14 4XW., Lister Hospital, Stevenage SG1 4AB UK., Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF., Queen Elizabeth University Hospital, Glasgow G51 4TF UK., Divison of Cancer & Stem Cells, School of Medicine, University of Nottingham, Nottingham UK., Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK., NHS Lothian, Edinburgh, UK., Oxford University Hospitals NHS Foundation Trust, Oxford UK., Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ UK.