Format

Send to

Choose Destination
J Urol. 2012 Mar;187(3):834-9. doi: 10.1016/j.juro.2011.10.155. Epub 2012 Jan 15.

Prognostic value of the Leibovich prognosis score supplemented by vascular invasion for clear cell renal cell carcinoma.

Author information

1
Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.

Abstract

PURPOSE:

We assessed whether supplementing the Leibovich prognosis score with vascular invasion would improve prognostic value to predict metastatic disease in patients with nonmetastatic clear cell renal cell carcinoma.

MATERIALS AND METHODS:

We retrospectively evaluated the pathology records of 1,754 patients with nonmetastatic clear cell renal cell carcinoma treated with surgery between 1984 and 2006 at a single tertiary academic center. The Leibovich prognosis score was supplemented by additional scoring for vascular invasion. Metastasis-free survival was assessed using the Kaplan-Meier method for each score category. A Cox regression model was used for multivariate testing. Predictive accuracy was determined by the Harrell concordance index and decision curve analysis.

RESULTS:

Median followup was 84 months. Ten-year metastasis-free survival probability for a score of 0 to 1 and 2 to 8 or greater was 95%, 83%, 78%, 81%, 69%, 51%, 15% and 13%, respectively. The concordance index was 0.792 compared to 0.778 from our external validation of the Leibovich prognosis score using routine pathological findings (p <0.05). Decision curve analysis also favored the predictive ability of the novel model.

CONCLUSIONS:

Adding vascular invasion improved the predictive accuracy of our validation data by 1.4% over that of the Leibovich prognosis score. Patients with a score of 7 or greater had a more than 85% probability of metastatic disease at 10 years. Thus, they could be considered candidates for adjuvant treatment trials.

PMID:
22245331
DOI:
10.1016/j.juro.2011.10.155
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center