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Validation of the online prediction tool PREDICT v. 2.0 in the Dutch breast cancer population

  • M.C. van Maaren
    Correspondence
    Corresponding author: Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB Utrecht, The Netherlands.
    Affiliations
    Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

    Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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  • C.D. van Steenbeek
    Affiliations
    Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

    Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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  • P.D.P. Pharoah
    Affiliations
    Department of Oncology, University of Cambridge, Cambridge, United Kingdom
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  • A. Witteveen
    Affiliations
    Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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  • G.S. Sonke
    Affiliations
    Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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  • L.J.A. Strobbe
    Affiliations
    Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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  • P.M.P. Poortmans
    Affiliations
    Department of Radiation Oncology, Institut Curie, Paris, France
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  • S. Siesling
    Affiliations
    Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands

    Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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Published:October 26, 2017DOI:https://doi.org/10.1016/j.ejca.2017.09.031

      Highlights

      • This study validates PREDICT version 2.0 in Dutch breast cancer patients.
      • PREDICT is a reliable prediction tool for Dutch breast cancer patients.
      • 10-year overall survival must be interpreted with care in some subgroups.
      • Before used in clinical practice, prediction tools should be validated.

      Abstract

      Background

      PREDICT version 2.0 is increasingly used to estimate prognosis in breast cancer. This study aimed to validate this tool in specific prognostic subgroups in the Netherlands.

      Methods

      All operated women with non-metastatic primary invasive breast cancer, diagnosed in 2005, were selected from the nationwide Netherlands Cancer Registry (NCR). Predicted and observed 5- and 10-year overall survival (OS) were compared for the overall cohort, separated by oestrogen receptor (ER) status, and predefined subgroups. A >5% difference was considered as clinically relevant. Discriminatory accuracy and goodness-of-fit were determined using the area under the receiver operating characteristic curve (AUC) and the Chi-squared-test.

      Results

      We included 8834 patients. Discriminatory accuracy for 5-year OS was good (AUC 0.80). For ER-positive and ER-negative patients, AUCs were 0.79 and 0.75, respectively. Predicted 5-year OS differed from observed by −1.4% in the entire cohort, −0.7% in ER-positive and −4.9% in ER-negative patients. Five-year OS was accurately predicted in all subgroups.
      Discriminatory accuracy for 10-year OS was good (AUC 0.78). For ER-positive and ER-negative patients AUCs were 0.78 and 0.76, respectively. Predicted 10-year OS differed from observed by −1.0% in the entire cohort, −0.1% in ER-positive and −5.3 in ER-negative patients. Ten-year OS was overestimated (6.3%) in patients ≥75 years and underestimated (−13.%) in T3 tumours and patients treated with both endocrine therapy and chemotherapy (−6.6%).

      Conclusions

      PREDICT predicts OS reliably in most Dutch breast cancer patients, although results for both 5-year and 10-year OS should be interpreted carefully in ER-negative patients. Furthermore, 10-year OS should be interpreted cautiously in patients ≥75 years, T3 tumours and in patients considering endocrine therapy and chemotherapy.

      Keywords

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