Correlation between Nottingham Prognostic Index and Adjuvant! Online prognostic tools in patients with early-stage breast cancer in Mid-Western Ireland

BACKGROUND

Prognostic tools are widely used in the practice of oncology and have been developed to help stratify patients into specific risk-related grouping. We sought to apply tool such tools used for patients with early-stage breast cancer (EBC) and correlate them to actual outcomes.

METHODS

A retrospective analysis was designed to include EBC cases seen at the Mid-Western Regional Hospital from January 1, 2002, to December 31, 2002. Information was derived from the patients' records, and indices were derived from prognostic tools. Information was analyzed using descriptive statistics and chi-square or Fisher exact test.

RESULTS

A total of 77 patients were found, with a median age of 52.2 years. A median overall survival (OS) of 84 months was observed. The majority presented with moderately differentiated estrogen receptor positive invasive ductal carcinoma and lymph node involvement (60%). Sixty-four percent of patients underwent mastectomy as opposed to breast conservation. Adjuvant cytotoxic chemotherapy uptake was 61%, which was comparable to the proportion of node positive disease. The Nottingham Prognostic Index and Adjuvant! Online (AO) tools were both correlated with actual survival, with the AO showing better correlation.

CONCLUSIONS

This report underscores that these predicting tools were both underestimations consistent with the actual OS and highlights the importance of further work in validating these tools within our own population.

Clinical validity/utility, change in practice patterns, and economic implications of risk stratifiers to predict outcomes for early-stage breast cancer: a systematic review

BACKGROUND

At least 14 stratifiers exist to assess recurrence risk, chemotherapy response, and overall survival (OS) in women with early-stage breast cancer (ESBC). These stratifiers have not been compared using a recently developed rigorous framework. We performed a systematic review of the literature on clinical validity/utility, change in clinical practice, and economic implications of ESBC stratifiers.

METHODS

A systematic literature search was performed using PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, and bibliographies of relevant studies. Data were extracted by two investigators and graded using a previously published framework. The Level-of-Evidence determination for each study was summarized, and the studies that provide evidence on change in clinical practice and economic implications are reported.

RESULTS

Fifty-six articles published original evidence addressing the 21-gene recurrence score (n = 31), 70-gene signature (n = 14), Adjuvant! Online (n = 12), 5-antibody immunohistochemistry panel (n = 3), 5-gene expression index (n = 1), and 14-gene signature (n = 1). The 21-gene recurrence score satisfied Level I evidence (the highest level of evidence among five levels) for estimating distant recurrence risk (DRR), OS, and response to adjuvant chemotherapy, and Level II for estimating local recurrence risk. The 5-antibody immunohistochemistry panel and 70-gene signature satisfied Level II evidence for estimating DRR and OS. Adjuvant! Online satisfied Level II evidence for estimating DRR, OS, and chemotherapy response. The 5-gene expression index satisfied Level III evidence for predicting DRR. The 14-gene signature satisfied Level III evidence for predicting DRR and OS. Ten studies reported changes in clinical practice patterns; seven studies reported economic implications.

CONCLUSION

The available evidence on the ability of stratifiers to predict risks of recurrence and response to chemotherapy in ESBC is growing. Level-of-Evidence determinations using the newer framework provide a solid scientific foundation for clinical recommendations.

External validation of Adjuvant! Online breast cancer prognosis tool. Prioritising recommendations for improvement

Background

Adjuvant! Online is a web-based application designed to provide 10 years survival probability of patients with breast cancer. Several predictors have not been assessed in the original Adjuvant! Online study. We provide the validation of Adjuvant! Online algorithm on two breast cancer datasets, and we determined whether the accuracy of Adjuvant! Online is improved with other well-known prognostic factors.

Patients and Methods

The French data set is composed of 456 women with early breast cancer. The Dutch data set is composed of 295 women less than 52 years of age. Agreement between observation and Adjuvant! Online prediction was checked, and logistic models were performed to estimate the prognostic information added by risk factors to Adjuvant! Online prediction.

Results

Adjuvant! Online prediction was overall well-calibrated in the French data set but failed in some subgroups of such high grade and HER2 positive patients. HER2 status, Mitotic Index and Ki67 added significant information to Adjuvant! Online prediction. In the Dutch data set, the overall 10-year survival was overestimated by Adjuvant! Online, particularly in patients less than 40 years old.

Conclusion

Adjuvant! Online needs to be updated to adjust overoptimistic results in young and high grade patients, and should consider new predictors such as Ki67, HER2 and Mitotic Index.