@article{discovery10144485,
         journal = {Journal of Clinical Oncology},
       publisher = {American Society of Clinical Oncology (ASCO)},
            year = {2022},
           title = {External Validation of the 2003 Leibovich Prognostic Score in Patients Randomly Assigned to SORCE, an International Phase III Trial of Adjuvant Sorafenib in Renal Cell Cancer},
            note = {This is an Open Access article made available under a Creative Commons Attribution Non-Commercial 4.0 License. See: https://creativecommons.org/licenses/by-nc/4.0/},
           month = {February},
          author = {Oza, Bhavna and Eisen, Tim and Frangou, Eleni and Stewart, Grant D and Bex, Axel and Ritchie, Alastair WS and Kaplan, Rick and Smith, Benjamin and Davis, Ian D and Stockler, Martin R and Albiges, Laurence and Escudier, Bernard and Larkin, James and Joniau, Steven and Hancock, Barry and Hermann, Gregers G and Bellmunt, Joaquim and Parmar, Mahesh KB and Royston, Patrick and Meade, Angela},
        abstract = {PURPOSE: The 2003 Leibovich score guides prognostication and selection to adjuvant clinical trials for patients with locally advanced renal cell carcinoma (RCC) after nephrectomy. We provide a robust external validation of the 2003 Leibovich score using contemporary data from SORCE, an international, randomized trial of sorafenib after excision of primary RCC. METHODS: Data used to derive the 2003 Leibovich score were compared with contemporary data from SORCE. Discrimination and calibration of the metastasis-free survival outcome were assessed in data from patients with clear-cell RCC, using Cox proportional hazards regression, Kaplan-Meier curves, and calculation of Harrell's c indexes. Secondary analyses involved three important SORCE groups: patients with any non-clear-cell subtype, papillary, and chromophobe carcinomas. RESULTS: Four hundred seven recurrences occurred in 982 patients in the Leibovich cohort and 520 recurrences were recorded in 1,445 patients in the primary SORCE cohort. Clear discrimination between intermediate-risk and high-risk SORCE cohorts was shown; hazard ratio 2.74 (95\% CI, 2.29 to 3.28), c-index 0.63 (95\% CI, 0.61 to 0.65). A hazard ratio of 0.61 (95\% CI, 0.53 to 0.70) confirmed poor calibration of the two cohorts. Discrimination was observed in secondary populations, with c-indexes of 0.64 (95\% CI, 0.59 to 0.69) for non-clear-cell RCC, 0.63 (95\% CI, 0.56 to 0.69) for papillary RCC, and 0.65 (95\% CI, 0.55 to 0.76) for chromophobe RCC. CONCLUSION: The 2003 Leibovich score discriminates between intermediate-risk and high-risk clear-cell and non-clear-cell RCC groups in contemporary data, supporting its use for risk stratification in adjuvant clinical trials. Over time, metastasis-free survival for patients with locally advanced RCC has improved. Contemporary data from adjuvant RCC trials should be used to improve prognostication for patients with RCC.},
             url = {https://doi.org/10.1200/JCO.21.01090}
}