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Prediction Model of Leibovich et al for Patients with Clear Cell Renal Cell Carcinoma After Radical Nephrectomy

Purpose: To determine risk for metastatic disease in a patient with a clinically localized clear cell renal cell carcinoma using the model of Leibovich et al.

Description

Leibovich et al developed a model for predicting survival in patients with the clear cell morphotype of renal cell carcinoma. This help counsel patients and to monitor outcome of clinical trials. The authors are from the Mayo Clinic.


NOTE: The score is similar to the SSIGN score, differing in some point assignments and the diameter of the tumor. Both scores were developed at the Mayo Clinic.

 

Patient selection:

(1) clinically localized disease (non-metastatic at time of surgery)

(2) clear cell morphotype

 

Parameters:

(1) pathologic T stage

(2) pathologic N stage (regional lymph node status)

(3) tumor size (diameter in cm)

(4) Fuhrman nuclear grade (based on highest grade occupying at least 1 high power field)

(5) histologic tumor necrosis

 

Parameter

 

 

 

Finding

Points

pathologic T stage

pT1a

0

 

pT1b

2

 

pT2

3

 

pT3a

4

 

pT3b

4

 

pT3c

4

 

pT4

4

pathologic N stage

pNx

0

 

pN0

0

 

pN1

2

 

pN2

2

tumor size

< 10 cm

0

 

>= 10 cm

1

nuclear grade

grade 1

0

 

grade 2

0

 

grade 3

1

 

grade 4

3

histologic tumor necrosis

absent

0

 

present

1

from Table 4, page 1668

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 11

• The higher the score the higher the risk for developing metastases and the shorter intervals for metastases free survival.

 

Score

Risk for Metastases

0, 1 or 2

low

3, 4 or 5

intermediate

6 to 11

high

 

 

 

Percent Metastases Free Survival

Score

Year 1

Year 5

Year 10

0 or 1

99.7

98.7

96.1

2

99.3

95.3

88.5

3

96.1

84.2

78.6

4

90.2

75.9

63.2

5

86.1

63.0

54.8

6

66.9

40.2

29.8

7

59.3

31.6

24.7

8 to 11

39.7

12.7

10.2

from Table 5, page 1669

 


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Specialty

Objective

ICD-10