Abstract
Purpose: Follow-up after breast cancer treatment aims for an early detection of locoregional breast cancer recurrences (LRR) to improve the patients’ outcome. By estimating individual’s 5-year recurrence-risks, the Dutch INFLUENCE-nomogram can assist health professionals and patients in developing personalized risk-based follow-up pathways. The objective of this study is to validate the prediction tool on non-Dutch patients. Material and methods: Data for this external validation derive from a large clinical cancer registry in southern Germany, covering a population of 1.1 million. Patients with curative resection of early-stage breast cancer, diagnosed between 2000 and 2012, were included in the analysis (n = 6520). For each of them, an individual LRR-risk was estimated by the INFLUENCE-nomogram. Its predictive ability was tested by comparing estimated and observed LRR-probabilities using the Hosmer–Lemeshow goodness-of-fit test and C-statistics. Results: In the German validation-cohort, 2.8% of the patients developed an LRR within 5 years after primary surgery (n = 184). While the INFLUENCE-nomogram generally underestimates the actual LRR-risk of the German patients (p < 0.001), its discriminative ability is comparable to the one observed in the original Dutch modeling-cohort (C-statistic German validation-cohort: 0.73, CI 0.69–0.77 vs. C-statistic Dutch modeling-cohort: 0.71, CI 0.69–0.73). Similar results were obtained in most of the subgroup analyses stratified by age, type of surgery and intrinsic biological subtypes. Conclusion: The outcomes of this external validation underline the generalizability of the INFLUENCE-nomogram beyond the Dutch population. The model performance could be enhanced in future by incorporating additional risk factors for LRR.
| Original language | English |
|---|---|
| Pages (from-to) | 1823-1833 |
| Number of pages | 11 |
| Journal | Journal of Cancer Research and Clinical Oncology |
| Volume | 145 |
| Issue number | 7 |
| Early online date | 29 Mar 2019 |
| DOIs | |
| Publication status | Published - 1 Jul 2019 |
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Predicting the risk of locoregional recurrence after early breast cancer : an external validation of the Dutch INFLUENCE-nomogram with clinical cancer registry data from Germany. / Voelkel, Vinzenz (Corresponding Author); Draeger, Teresa Maria Cornelia; Oudshoorn, C; de Munck, Linda; Hueting, Tom; Gerken, Michael; Klinkhammer-Schalke, Monika; Lavric, Miha ; Siesling, Sabine .
In: Journal of Cancer Research and Clinical Oncology, Vol. 145, No. 7, 01.07.2019, p. 1823-1833.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Predicting the risk of locoregional recurrence after early breast cancer
T2 - an external validation of the Dutch INFLUENCE-nomogram with clinical cancer registry data from Germany
AU - Voelkel, Vinzenz
AU - Draeger, Teresa Maria Cornelia
AU - Oudshoorn, C
AU - de Munck, Linda
AU - Hueting, Tom
AU - Gerken, Michael
AU - Klinkhammer-Schalke, Monika
AU - Lavric, Miha
AU - Siesling, Sabine
N1 - Springer deal
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Purpose: Follow-up after breast cancer treatment aims for an early detection of locoregional breast cancer recurrences (LRR) to improve the patients’ outcome. By estimating individual’s 5-year recurrence-risks, the Dutch INFLUENCE-nomogram can assist health professionals and patients in developing personalized risk-based follow-up pathways. The objective of this study is to validate the prediction tool on non-Dutch patients. Material and methods: Data for this external validation derive from a large clinical cancer registry in southern Germany, covering a population of 1.1 million. Patients with curative resection of early-stage breast cancer, diagnosed between 2000 and 2012, were included in the analysis (n = 6520). For each of them, an individual LRR-risk was estimated by the INFLUENCE-nomogram. Its predictive ability was tested by comparing estimated and observed LRR-probabilities using the Hosmer–Lemeshow goodness-of-fit test and C-statistics. Results: In the German validation-cohort, 2.8% of the patients developed an LRR within 5 years after primary surgery (n = 184). While the INFLUENCE-nomogram generally underestimates the actual LRR-risk of the German patients (p < 0.001), its discriminative ability is comparable to the one observed in the original Dutch modeling-cohort (C-statistic German validation-cohort: 0.73, CI 0.69–0.77 vs. C-statistic Dutch modeling-cohort: 0.71, CI 0.69–0.73). Similar results were obtained in most of the subgroup analyses stratified by age, type of surgery and intrinsic biological subtypes. Conclusion: The outcomes of this external validation underline the generalizability of the INFLUENCE-nomogram beyond the Dutch population. The model performance could be enhanced in future by incorporating additional risk factors for LRR.
AB - Purpose: Follow-up after breast cancer treatment aims for an early detection of locoregional breast cancer recurrences (LRR) to improve the patients’ outcome. By estimating individual’s 5-year recurrence-risks, the Dutch INFLUENCE-nomogram can assist health professionals and patients in developing personalized risk-based follow-up pathways. The objective of this study is to validate the prediction tool on non-Dutch patients. Material and methods: Data for this external validation derive from a large clinical cancer registry in southern Germany, covering a population of 1.1 million. Patients with curative resection of early-stage breast cancer, diagnosed between 2000 and 2012, were included in the analysis (n = 6520). For each of them, an individual LRR-risk was estimated by the INFLUENCE-nomogram. Its predictive ability was tested by comparing estimated and observed LRR-probabilities using the Hosmer–Lemeshow goodness-of-fit test and C-statistics. Results: In the German validation-cohort, 2.8% of the patients developed an LRR within 5 years after primary surgery (n = 184). While the INFLUENCE-nomogram generally underestimates the actual LRR-risk of the German patients (p < 0.001), its discriminative ability is comparable to the one observed in the original Dutch modeling-cohort (C-statistic German validation-cohort: 0.73, CI 0.69–0.77 vs. C-statistic Dutch modeling-cohort: 0.71, CI 0.69–0.73). Similar results were obtained in most of the subgroup analyses stratified by age, type of surgery and intrinsic biological subtypes. Conclusion: The outcomes of this external validation underline the generalizability of the INFLUENCE-nomogram beyond the Dutch population. The model performance could be enhanced in future by incorporating additional risk factors for LRR.
KW - UT-Hybrid-D
U2 - 10.1007/s00432-019-02904-4
DO - 10.1007/s00432-019-02904-4
M3 - Article
VL - 145
SP - 1823
EP - 1833
JO - Journal of Cancer Research and Clinical Oncology
JF - Journal of Cancer Research and Clinical Oncology
SN - 0171-5216
IS - 7
ER -