van Maaren M C, van Steenbeek C D, Pharoah P D P, Witteveen A, Sonke G S, Strobbe L J A, Poortmans P M P, Siesling S
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.
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.
Eur J Cancer. 2017 Nov;86:364-372. doi: 10.1016/j.ejca.2017.09.031. Epub 2017 Nov 5.
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.
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.
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%).
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.
PREDICT 2.0版越来越多地用于评估乳腺癌的预后。本研究旨在在荷兰的特定预后亚组中验证该工具。
从全国性的荷兰癌症登记处（NCR）中选取2005年诊断为非转移性原发性浸润性乳腺癌的所有接受手术的女性。比较整个队列、按雌激素受体（ER）状态划分的队列以及预定义亚组的预测和观察到的5年和10年总生存率（OS）。差异>5%被认为具有临床相关性。使用受试者工作特征曲线下面积（AUC）和卡方检验确定鉴别准确性和拟合优度。
我们纳入了8834例患者。5年总生存率的鉴别准确性良好（AUC为0.80）。对于ER阳性和ER阴性患者，AUC分别为0.79和0.75。整个队列中预测的5年总生存率与观察值相差-1.4%，ER阳性患者中相差-0.7%，ER阴性患者中相差-4.9%。所有亚组的5年总生存率均得到准确预测。10年总生存率的鉴别准确性良好（AUC为0.78）。对于ER阳性和ER阴性患者，AUC分别为0.78和0.76。整个队列中预测的10年总生存率与观察值相差-1.0%，ER阳性患者中相差-0.1%，ER阴性患者中相差-5.3%。75岁及以上患者的10年总生存率被高估（6.3%），T3肿瘤患者以及接受内分泌治疗和化疗的患者被低估（-13.%）和（-6.6%）。
PREDICT在大多数荷兰乳腺癌患者中能可靠地预测总生存率，尽管对于ER阴性患者的5年和10年总生存率结果都应谨慎解读。此外，对于75岁及以上患者、T3肿瘤患者以及考虑接受内分泌治疗和化疗的患者，应谨慎解读10年总生存率。
