title: Prognostic value of the Leibovich prognosis score supplemented by vascular invasion for clear cell renal cell carcinoma.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Chromecki
authors.forename: Johanna
authors.initials: J
authors.lastname: Jesche
authors.forename: Andrea
authors.initials: A
authors.lastname: Groselj-Strele
authors.forename: Karin
authors.initials: K
authors.lastname: Kampel-Kettner
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D014680:Veins / Q000473:pathology*