Journal Article
. 2005 Apr;23(12).
doi: 10.1200/JCO.2005.06.178.

Population-based validation of the prognostic model ADJUVANT! for early breast cancer

Ivo A Olivotto 1 Chris D Bajdik  Peter M Ravdin  Caroline H Speers  Andrew J Coldman  Brian D Norris  Greg J Davis  Stephen K Chia  Karen A Gelmon  
  • PMID: 15837986
  •     156 citations


Purpose: Adjuvant! ( is a web-based tool that predicts 10-year breast cancer outcomes with and without adjuvant systemic therapy, but it has not been independently validated.

Methods: Using the British Columbia Breast Cancer Outcomes Unit (BCOU) database, demographic, pathologic, staging, and treatment data on 4,083 women diagnosed between 1989 and 1993 in British Columbia with T1-2, N0-1, M0 breast cancer were abstracted and entered into Adjuvant! to calculate predicted 10-year overall survival (OS), breast cancer-specific survival (BCSS), and event-free survival (EFS) for each patient. Individual BCOU observed outcomes at 10 years were independently determined. Predicted and observed outcomes were compared.

Results: Across all 4,083 patients, 10-year predicted and observed outcomes were within 1% for OS, BCSS, and EFS (all P > .05). Predicted and observed outcomes were within 2% for most demographic, pathologic, and treatment-defined subgroups. Adjuvant! overestimated OS, BCSS, and EFS in women younger than age 35 years (predicted-observed = 8.6%, 9.6%, and 13.6%, respectively; all P < .001) or with lymphatic or vascular invasion (LVI; predicted-observed = 3.6%, 3.8%, and 4.2%, respectively; all P < .05); these two prognostic factors were not automatically incorporated within the Adjuvant! algorithm. After adjusting for the distribution of LVI, using the prognostic factor impact calculator in Adjuvant!, 10-year predicted and observed outcomes were no longer significantly different.

Conclusion: Adjuvant! performed reliably. Patients younger than age 35 or with known additional adverse prognostic factors such as LVI require adjustment of risks to derive reliable predictions of prognosis without adjuvant systemic therapy and the absolute benefits of adjuvant systemic therapy.

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From High-Throughput Microarray-Based Screening to Clinical Application: The Development of a Second Generation Multigene Test for Breast Cancer Prognosis.
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Comparison of the Ability of Different Clinical Treatment Scores to Estimate Prognosis in High-Risk Early Breast Cancer Patients: A Hellenic Cooperative Oncology Group Study.
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PLoS One, 2016 Oct 04; 11(10). PMID: 27695115    Free PMC article.
Validation of the CancerMath prognostic tool for breast cancer in Southeast Asia.
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BMC Cancer, 2016 Oct 23; 16(1). PMID: 27769212    Free PMC article.
The prognostic performance of Adjuvant! Online and Nottingham Prognostic Index in young breast cancer patients.
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Br J Cancer, 2016 Nov 02; 115(12). PMID: 27802449    Free PMC article.
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BMC Cancer, 2016 Dec 03; 16(1). PMID: 27905893    Free PMC article.
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Cancer, 2017 Feb 16; 123(13). PMID: 28199747    Free PMC article.
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Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update.
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Maura Bríd Cotter, Alex Dakin, +5 authors, Cecily M Quinn.
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Chemotherapy in a Breast Cancer Patient Heterozygous Carrier of Ornithine Transcarbamylase Deficiency.
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Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative.
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Br J Cancer, 2021 Feb 19;. PMID: 33597715