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The predictive accuracy of PREDICT: a personalized decision-making tool for Southeast Asian women with breast cancer.

Wong HS, Subramaniam S, Alias Z, Taib NA, Ho GF, Ng CH, Yip CH, Verkooijen HM, Hartman M, Bhoo-Pathy N - Medicine (Baltimore) (2015)

Bottom Line: Overall, the model-predicted 5 and 10-year OS was 86.3% and 77.5%, respectively, whereas the observed 5 and 10-year OS was 87.6% (difference: -1.3%) and 74.2% (difference: 3.3%), respectively; P values for goodness-of-fit test were 0.18 and 0.12, respectively.The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged <40 years, and in those receiving neoadjuvant chemotherapy.PREDICT performed well in terms of discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively.

View Article: PubMed Central - PubMed

Affiliation: From the National Clinical Research Centre (HSW, SS), Level 3, Dermatology Block, Kuala Lumpur Hospital, Jalan Pahang; Department of Surgery (ZA, NAT, CHN, CHY); Department of Oncology (GFH), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Imaging Division (HMV), University Medical Center Utrecht, Utrecht, The Netherlands; Saw Swee Hock School of Public Health (HMV, MH), National University of Singapore; Department of Surgery (MH), Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; Julius Centre University of Malaya (NBP), Centre for Clinical Epidemiology and Evidence-Based Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Julius Center for Health Sciences and Primary Care (NBP), University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT
Web-based prognostication tools may provide a simple and economically feasible option to aid prognostication and selection of chemotherapy in early breast cancers. We validated PREDICT, a free online breast cancer prognostication and treatment benefit tool, in a resource-limited setting. All 1480 patients who underwent complete surgical treatment for stages I to III breast cancer from 1998 to 2006 were identified from the prospective breast cancer registry of University Malaya Medical Centre, Kuala Lumpur, Malaysia. Calibration was evaluated by comparing the model-predicted overall survival (OS) with patients' actual OS. Model discrimination was tested using receiver-operating characteristic (ROC) analysis. Median age at diagnosis was 50 years. The median tumor size at presentation was 3 cm and 54% of patients had lymph node-negative disease. About 55% of women had estrogen receptor-positive breast cancer. Overall, the model-predicted 5 and 10-year OS was 86.3% and 77.5%, respectively, whereas the observed 5 and 10-year OS was 87.6% (difference: -1.3%) and 74.2% (difference: 3.3%), respectively; P values for goodness-of-fit test were 0.18 and 0.12, respectively. The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged <40 years, and in those receiving neoadjuvant chemotherapy. PREDICT performed well in terms of discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively. Based on its accurate performance in this study, PREDICT may be clinically useful in prognosticating women with breast cancer and personalizing breast cancer treatment in resource-limited settings.

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Related in: MedlinePlus

Calibration plot of observed mortality with 95% confidence interval against predicted mortality by quintiles of the predicted value, at (A) 5 and (B) 10 years after diagnosis.
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Figure 2: Calibration plot of observed mortality with 95% confidence interval against predicted mortality by quintiles of the predicted value, at (A) 5 and (B) 10 years after diagnosis.

Mentions: Overall, PREDICT was accurate in predicting short-term survival; the predicted 5-year OS was 86.3% versus the actual observed 5-year OS that was 87.6% (difference: −1.3%). The P value for goodness-of-fit test was 0.18. However, the tool slightly overestimated long-term survival; the predicted 10-year OS was 77.5% whereas the observed 10-year OS was 74.2% (difference: 3.3%). The corresponding P value for goodness-of-fit test for 10-year OS was 0.12. The program seems to have performed fairly well in patients with good prognosis and only displayed overoptimism in patients with the poorest prognosis (lowest quintile) (Figure 2).


The predictive accuracy of PREDICT: a personalized decision-making tool for Southeast Asian women with breast cancer.

Wong HS, Subramaniam S, Alias Z, Taib NA, Ho GF, Ng CH, Yip CH, Verkooijen HM, Hartman M, Bhoo-Pathy N - Medicine (Baltimore) (2015)

Calibration plot of observed mortality with 95% confidence interval against predicted mortality by quintiles of the predicted value, at (A) 5 and (B) 10 years after diagnosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554151&req=5

Figure 2: Calibration plot of observed mortality with 95% confidence interval against predicted mortality by quintiles of the predicted value, at (A) 5 and (B) 10 years after diagnosis.
Mentions: Overall, PREDICT was accurate in predicting short-term survival; the predicted 5-year OS was 86.3% versus the actual observed 5-year OS that was 87.6% (difference: −1.3%). The P value for goodness-of-fit test was 0.18. However, the tool slightly overestimated long-term survival; the predicted 10-year OS was 77.5% whereas the observed 10-year OS was 74.2% (difference: 3.3%). The corresponding P value for goodness-of-fit test for 10-year OS was 0.12. The program seems to have performed fairly well in patients with good prognosis and only displayed overoptimism in patients with the poorest prognosis (lowest quintile) (Figure 2).

Bottom Line: Overall, the model-predicted 5 and 10-year OS was 86.3% and 77.5%, respectively, whereas the observed 5 and 10-year OS was 87.6% (difference: -1.3%) and 74.2% (difference: 3.3%), respectively; P values for goodness-of-fit test were 0.18 and 0.12, respectively.The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged <40 years, and in those receiving neoadjuvant chemotherapy.PREDICT performed well in terms of discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively.

View Article: PubMed Central - PubMed

Affiliation: From the National Clinical Research Centre (HSW, SS), Level 3, Dermatology Block, Kuala Lumpur Hospital, Jalan Pahang; Department of Surgery (ZA, NAT, CHN, CHY); Department of Oncology (GFH), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Imaging Division (HMV), University Medical Center Utrecht, Utrecht, The Netherlands; Saw Swee Hock School of Public Health (HMV, MH), National University of Singapore; Department of Surgery (MH), Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; Julius Centre University of Malaya (NBP), Centre for Clinical Epidemiology and Evidence-Based Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and Julius Center for Health Sciences and Primary Care (NBP), University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT
Web-based prognostication tools may provide a simple and economically feasible option to aid prognostication and selection of chemotherapy in early breast cancers. We validated PREDICT, a free online breast cancer prognostication and treatment benefit tool, in a resource-limited setting. All 1480 patients who underwent complete surgical treatment for stages I to III breast cancer from 1998 to 2006 were identified from the prospective breast cancer registry of University Malaya Medical Centre, Kuala Lumpur, Malaysia. Calibration was evaluated by comparing the model-predicted overall survival (OS) with patients' actual OS. Model discrimination was tested using receiver-operating characteristic (ROC) analysis. Median age at diagnosis was 50 years. The median tumor size at presentation was 3 cm and 54% of patients had lymph node-negative disease. About 55% of women had estrogen receptor-positive breast cancer. Overall, the model-predicted 5 and 10-year OS was 86.3% and 77.5%, respectively, whereas the observed 5 and 10-year OS was 87.6% (difference: -1.3%) and 74.2% (difference: 3.3%), respectively; P values for goodness-of-fit test were 0.18 and 0.12, respectively. The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged <40 years, and in those receiving neoadjuvant chemotherapy. PREDICT performed well in terms of discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively. Based on its accurate performance in this study, PREDICT may be clinically useful in prognosticating women with breast cancer and personalizing breast cancer treatment in resource-limited settings.

Show MeSH
Related in: MedlinePlus