Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years

Ellen G. Engelhardt, Alexandra J. van den Broek, Sabine C. Linn, Gordon C. Wishart, Emiel J.Th Rutgers, Anthonie O. van de Velde, Vincent T.H.B.M. Smit, Adri C. Voogd, Sabine Siesling, Mariël Brinkhuis, Caroline Seynaeve, Pieter J. Westenend, Anne M. Stiggelbout, Rob A.E.M. Tollenaar, Flora E. van Leeuwen, Laura J. van ‘t Veer, Peter M. Ravdin, Paul D.P. Pharaoh, Marjanka K. Schmidt*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)

Abstract

Importance Online prognostication tools such as PREDICT and Adjuvant! are increasingly used in clinical practice by oncologists to inform patients and guide treatment decisions about adjuvant systemic therapy. However, their validity for young breast cancer patients is debated. Objective To assess first, the prognostic accuracy of PREDICT's and Adjuvant! 10-year all-cause mortality, and second, its breast cancer–specific mortality estimates, in a large cohort of breast cancer patients diagnosed <50 years. Design Hospital-based cohort. Setting General and cancer hospitals. Participants A consecutive series of 2710 patients without a prior history of cancer, diagnosed between 1990 and 2000 with unilateral stage I–III breast cancer aged <50 years. Main outcome measures Calibration and discriminatory accuracy, measured with C-statistics, of estimated 10-year all-cause and breast cancer–specific mortality. Results Overall, PREDICT's calibration for all-cause mortality was good (predicted versus observed) meandifference: −1.1% (95%CI: −3.2%–0.9%; P = 0.28). PREDICT tended to underestimate all-cause mortality in good prognosis subgroups (range meandifference: −2.9% to −4.8%), overestimated all-cause mortality in poor prognosis subgroups (range meandifference: 2.6%–9.4%) and underestimated survival in patients < 35 by −6.6%. Overall, PREDICT overestimated breast cancer–specific mortality by 3.2% (95%CI: 0.8%–5.6%; P = 0.007); and also overestimated it seemingly indiscriminately in numerous subgroups (range meandifference: 3.2%–14.1%). Calibration was poor in the cohort of patients with the lowest and those with the highest mortality probabilities. Discriminatory accuracy was moderate-to-good for all-cause mortality in PREDICT (0.71 [95%CI: 0.68 to 0.73]), and the results were similar for breast cancer–specific mortality. Adjuvant!'s calibration and discriminatory accuracy for both all-cause and breast cancer–specific mortality were in line with PREDICT's findings. Conclusions Although imprecise at the extremes, PREDICT's estimates of 10-year all-cause mortality seem reasonably sound for breast cancer patients <50 years; Adjuvant! findings were similar. Prognostication tools should be used with caution due to the intrinsic variability of their estimates, and because the threshold to discuss adjuvant systemic treatment is low. Thus, seemingly insignificant mortality overestimations or underestimations of a few percentages can significantly impact treatment decision-making.

Original languageEnglish
Pages (from-to)37-44
Number of pages8
JournalEuropean journal of cancer
Volume78
DOIs
Publication statusPublished - 1 Jun 2017

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Breast Neoplasms
Mortality
Breast
Calibration
Hospital Design and Construction
Cancer Care Facilities
Therapeutics
General Hospitals
Decision Making
Outcome Assessment (Health Care)
Survival

Keywords

  • Adjuvant!
  • Breast cancer
  • PREDICT
  • Prognostic accuracy
  • Prognostication tool
  • Young patients

Cite this

Engelhardt, E. G., van den Broek, A. J., Linn, S. C., Wishart, G. C., Rutgers, E. J. T., van de Velde, A. O., ... Schmidt, M. K. (2017). Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years. European journal of cancer, 78, 37-44. https://doi.org/10.1016/j.ejca.2017.03.015
Engelhardt, Ellen G. ; van den Broek, Alexandra J. ; Linn, Sabine C. ; Wishart, Gordon C. ; Rutgers, Emiel J.Th ; van de Velde, Anthonie O. ; Smit, Vincent T.H.B.M. ; Voogd, Adri C. ; Siesling, Sabine ; Brinkhuis, Mariël ; Seynaeve, Caroline ; Westenend, Pieter J. ; Stiggelbout, Anne M. ; Tollenaar, Rob A.E.M. ; van Leeuwen, Flora E. ; van ‘t Veer, Laura J. ; Ravdin, Peter M. ; Pharaoh, Paul D.P. ; Schmidt, Marjanka K. / Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years. In: European journal of cancer. 2017 ; Vol. 78. pp. 37-44.
@article{6cce4ab1c1b8431a81825103e3f6f652,
title = "Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years",
abstract = "Importance Online prognostication tools such as PREDICT and Adjuvant! are increasingly used in clinical practice by oncologists to inform patients and guide treatment decisions about adjuvant systemic therapy. However, their validity for young breast cancer patients is debated. Objective To assess first, the prognostic accuracy of PREDICT's and Adjuvant! 10-year all-cause mortality, and second, its breast cancer–specific mortality estimates, in a large cohort of breast cancer patients diagnosed <50 years. Design Hospital-based cohort. Setting General and cancer hospitals. Participants A consecutive series of 2710 patients without a prior history of cancer, diagnosed between 1990 and 2000 with unilateral stage I–III breast cancer aged <50 years. Main outcome measures Calibration and discriminatory accuracy, measured with C-statistics, of estimated 10-year all-cause and breast cancer–specific mortality. Results Overall, PREDICT's calibration for all-cause mortality was good (predicted versus observed) meandifference: −1.1{\%} (95{\%}CI: −3.2{\%}–0.9{\%}; P = 0.28). PREDICT tended to underestimate all-cause mortality in good prognosis subgroups (range meandifference: −2.9{\%} to −4.8{\%}), overestimated all-cause mortality in poor prognosis subgroups (range meandifference: 2.6{\%}–9.4{\%}) and underestimated survival in patients < 35 by −6.6{\%}. Overall, PREDICT overestimated breast cancer–specific mortality by 3.2{\%} (95{\%}CI: 0.8{\%}–5.6{\%}; P = 0.007); and also overestimated it seemingly indiscriminately in numerous subgroups (range meandifference: 3.2{\%}–14.1{\%}). Calibration was poor in the cohort of patients with the lowest and those with the highest mortality probabilities. Discriminatory accuracy was moderate-to-good for all-cause mortality in PREDICT (0.71 [95{\%}CI: 0.68 to 0.73]), and the results were similar for breast cancer–specific mortality. Adjuvant!'s calibration and discriminatory accuracy for both all-cause and breast cancer–specific mortality were in line with PREDICT's findings. Conclusions Although imprecise at the extremes, PREDICT's estimates of 10-year all-cause mortality seem reasonably sound for breast cancer patients <50 years; Adjuvant! findings were similar. Prognostication tools should be used with caution due to the intrinsic variability of their estimates, and because the threshold to discuss adjuvant systemic treatment is low. Thus, seemingly insignificant mortality overestimations or underestimations of a few percentages can significantly impact treatment decision-making.",
keywords = "Adjuvant!, Breast cancer, PREDICT, Prognostic accuracy, Prognostication tool, Young patients",
author = "Engelhardt, {Ellen G.} and {van den Broek}, {Alexandra J.} and Linn, {Sabine C.} and Wishart, {Gordon C.} and Rutgers, {Emiel J.Th} and {van de Velde}, {Anthonie O.} and Smit, {Vincent T.H.B.M.} and Voogd, {Adri C.} and Sabine Siesling and Mari{\"e}l Brinkhuis and Caroline Seynaeve and Westenend, {Pieter J.} and Stiggelbout, {Anne M.} and Tollenaar, {Rob A.E.M.} and {van Leeuwen}, {Flora E.} and {van ‘t Veer}, {Laura J.} and Ravdin, {Peter M.} and Pharaoh, {Paul D.P.} and Schmidt, {Marjanka K.}",
year = "2017",
month = "6",
day = "1",
doi = "10.1016/j.ejca.2017.03.015",
language = "English",
volume = "78",
pages = "37--44",
journal = "European journal of cancer",
issn = "0959-8049",
publisher = "Elsevier",

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Engelhardt, EG, van den Broek, AJ, Linn, SC, Wishart, GC, Rutgers, EJT, van de Velde, AO, Smit, VTHBM, Voogd, AC, Siesling, S, Brinkhuis, M, Seynaeve, C, Westenend, PJ, Stiggelbout, AM, Tollenaar, RAEM, van Leeuwen, FE, van ‘t Veer, LJ, Ravdin, PM, Pharaoh, PDP & Schmidt, MK 2017, 'Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years', European journal of cancer, vol. 78, pp. 37-44. https://doi.org/10.1016/j.ejca.2017.03.015

Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years. / Engelhardt, Ellen G.; van den Broek, Alexandra J.; Linn, Sabine C.; Wishart, Gordon C.; Rutgers, Emiel J.Th; van de Velde, Anthonie O.; Smit, Vincent T.H.B.M.; Voogd, Adri C.; Siesling, Sabine; Brinkhuis, Mariël; Seynaeve, Caroline; Westenend, Pieter J.; Stiggelbout, Anne M.; Tollenaar, Rob A.E.M.; van Leeuwen, Flora E.; van ‘t Veer, Laura J.; Ravdin, Peter M.; Pharaoh, Paul D.P.; Schmidt, Marjanka K.

In: European journal of cancer, Vol. 78, 01.06.2017, p. 37-44.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years

AU - Engelhardt, Ellen G.

AU - van den Broek, Alexandra J.

AU - Linn, Sabine C.

AU - Wishart, Gordon C.

AU - Rutgers, Emiel J.Th

AU - van de Velde, Anthonie O.

AU - Smit, Vincent T.H.B.M.

AU - Voogd, Adri C.

AU - Siesling, Sabine

AU - Brinkhuis, Mariël

AU - Seynaeve, Caroline

AU - Westenend, Pieter J.

AU - Stiggelbout, Anne M.

AU - Tollenaar, Rob A.E.M.

AU - van Leeuwen, Flora E.

AU - van ‘t Veer, Laura J.

AU - Ravdin, Peter M.

AU - Pharaoh, Paul D.P.

AU - Schmidt, Marjanka K.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Importance Online prognostication tools such as PREDICT and Adjuvant! are increasingly used in clinical practice by oncologists to inform patients and guide treatment decisions about adjuvant systemic therapy. However, their validity for young breast cancer patients is debated. Objective To assess first, the prognostic accuracy of PREDICT's and Adjuvant! 10-year all-cause mortality, and second, its breast cancer–specific mortality estimates, in a large cohort of breast cancer patients diagnosed <50 years. Design Hospital-based cohort. Setting General and cancer hospitals. Participants A consecutive series of 2710 patients without a prior history of cancer, diagnosed between 1990 and 2000 with unilateral stage I–III breast cancer aged <50 years. Main outcome measures Calibration and discriminatory accuracy, measured with C-statistics, of estimated 10-year all-cause and breast cancer–specific mortality. Results Overall, PREDICT's calibration for all-cause mortality was good (predicted versus observed) meandifference: −1.1% (95%CI: −3.2%–0.9%; P = 0.28). PREDICT tended to underestimate all-cause mortality in good prognosis subgroups (range meandifference: −2.9% to −4.8%), overestimated all-cause mortality in poor prognosis subgroups (range meandifference: 2.6%–9.4%) and underestimated survival in patients < 35 by −6.6%. Overall, PREDICT overestimated breast cancer–specific mortality by 3.2% (95%CI: 0.8%–5.6%; P = 0.007); and also overestimated it seemingly indiscriminately in numerous subgroups (range meandifference: 3.2%–14.1%). Calibration was poor in the cohort of patients with the lowest and those with the highest mortality probabilities. Discriminatory accuracy was moderate-to-good for all-cause mortality in PREDICT (0.71 [95%CI: 0.68 to 0.73]), and the results were similar for breast cancer–specific mortality. Adjuvant!'s calibration and discriminatory accuracy for both all-cause and breast cancer–specific mortality were in line with PREDICT's findings. Conclusions Although imprecise at the extremes, PREDICT's estimates of 10-year all-cause mortality seem reasonably sound for breast cancer patients <50 years; Adjuvant! findings were similar. Prognostication tools should be used with caution due to the intrinsic variability of their estimates, and because the threshold to discuss adjuvant systemic treatment is low. Thus, seemingly insignificant mortality overestimations or underestimations of a few percentages can significantly impact treatment decision-making.

AB - Importance Online prognostication tools such as PREDICT and Adjuvant! are increasingly used in clinical practice by oncologists to inform patients and guide treatment decisions about adjuvant systemic therapy. However, their validity for young breast cancer patients is debated. Objective To assess first, the prognostic accuracy of PREDICT's and Adjuvant! 10-year all-cause mortality, and second, its breast cancer–specific mortality estimates, in a large cohort of breast cancer patients diagnosed <50 years. Design Hospital-based cohort. Setting General and cancer hospitals. Participants A consecutive series of 2710 patients without a prior history of cancer, diagnosed between 1990 and 2000 with unilateral stage I–III breast cancer aged <50 years. Main outcome measures Calibration and discriminatory accuracy, measured with C-statistics, of estimated 10-year all-cause and breast cancer–specific mortality. Results Overall, PREDICT's calibration for all-cause mortality was good (predicted versus observed) meandifference: −1.1% (95%CI: −3.2%–0.9%; P = 0.28). PREDICT tended to underestimate all-cause mortality in good prognosis subgroups (range meandifference: −2.9% to −4.8%), overestimated all-cause mortality in poor prognosis subgroups (range meandifference: 2.6%–9.4%) and underestimated survival in patients < 35 by −6.6%. Overall, PREDICT overestimated breast cancer–specific mortality by 3.2% (95%CI: 0.8%–5.6%; P = 0.007); and also overestimated it seemingly indiscriminately in numerous subgroups (range meandifference: 3.2%–14.1%). Calibration was poor in the cohort of patients with the lowest and those with the highest mortality probabilities. Discriminatory accuracy was moderate-to-good for all-cause mortality in PREDICT (0.71 [95%CI: 0.68 to 0.73]), and the results were similar for breast cancer–specific mortality. Adjuvant!'s calibration and discriminatory accuracy for both all-cause and breast cancer–specific mortality were in line with PREDICT's findings. Conclusions Although imprecise at the extremes, PREDICT's estimates of 10-year all-cause mortality seem reasonably sound for breast cancer patients <50 years; Adjuvant! findings were similar. Prognostication tools should be used with caution due to the intrinsic variability of their estimates, and because the threshold to discuss adjuvant systemic treatment is low. Thus, seemingly insignificant mortality overestimations or underestimations of a few percentages can significantly impact treatment decision-making.

KW - Adjuvant!

KW - Breast cancer

KW - PREDICT

KW - Prognostic accuracy

KW - Prognostication tool

KW - Young patients

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DO - 10.1016/j.ejca.2017.03.015

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