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  
Affiliations
  • PMID: 15837986
  •     156 citations

Abstract

Purpose: Adjuvant! (www.adjuvantonline.com) 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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Gynecol Oncol, 2016 Mar 10; 141(2). PMID: 26957478    Free PMC article.
The Role of the 21-Gene Recurrence Score in Breast Cancer Treatment.
Josee-Lyne Ethier, Eitan Amir.
Mol Diagn Ther, 2016 May 29; 20(4). PMID: 27235162
Review.
Breast cancer multigene testing trends and impact on chemotherapy use.
G Thomas Ray, Jeanne Mandelblatt, +4 authors, Tracy A Lieu.
Am J Manag Care, 2016 Jun 09; 22(5). PMID: 27266581    Free PMC article.
From High-Throughput Microarray-Based Screening to Clinical Application: The Development of a Second Generation Multigene Test for Breast Cancer Prognosis.
Jan C Brase, Ralf Kronenwett, +2 authors, Marcus Schmidt.
Microarrays (Basel), 2013 Jan 01; 2(3). PMID: 27605191    Free PMC article.
Review.
Prognostic models in male breast cancer.
Carmen C van der Pol, Miangela M Lacle, +7 authors, Paul J van Diest.
Breast Cancer Res Treat, 2016 Sep 28; 160(2). PMID: 27671991    Free PMC article.
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.
Flora Stavridi, Konstantine T Kalogeras, +19 authors, George Fountzilas.
PLoS One, 2016 Oct 04; 11(10). PMID: 27695115    Free PMC article.
Validation of the CancerMath prognostic tool for breast cancer in Southeast Asia.
Hui Miao, Mikael Hartman, +8 authors, Nirmala Bhoo-Pathy.
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.
Matteo Lambertini, Ana Catarina Pinto, +12 authors, Hatem A Azim.
Br J Cancer, 2016 Nov 02; 115(12). PMID: 27802449    Free PMC article.
Computational prediction of multidisciplinary team decision-making for adjuvant breast cancer drug therapies: a machine learning approach.
Frank P Y Lin, Adrian Pokorny, +2 authors, Richard J Epstein.
BMC Cancer, 2016 Dec 03; 16(1). PMID: 27905893    Free PMC article.
Outcomes in patients with early-stage breast cancer who underwent a 21-gene expression assay.
Carlos H Barcenas, Akshara Raghavendra, +10 authors, Debu Tripathy.
Cancer, 2017 Feb 16; 123(13). PMID: 28199747    Free PMC article.
A Comprehensive Model for Predicting Recurrence and Survival in Cases of Chinese Postoperative Invasive Breast Cancer
Xianhe Xie, Yanfen Hu, +7 authors, Weili Zheng.
Asian Pac J Cancer Prev, 2017 Apr 27; 18(3). PMID: 28441706    Free PMC article.
Clinical utility of gene-expression signatures in early stage breast cancer.
Maryann Kwa, Andreas Makris, Francisco J Esteva.
Nat Rev Clin Oncol, 2017 Jun 01; 14(10). PMID: 28561071
Highly Cited. Review.
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.
Ian Krop, Nofisat Ismaila, +10 authors, Vered Stearns.
J Clin Oncol, 2017 Jul 12; 35(24). PMID: 28692382    Free PMC article.
Highly Cited.
Comparison of Oncotype DX® Recurrence Score® with other risk assessment tools including the Nottingham Prognostic Index in the identification of patients with low-risk invasive breast cancer.
Maura Bríd Cotter, Alex Dakin, +5 authors, Cecily M Quinn.
Virchows Arch, 2017 Jul 15; 471(3). PMID: 28707056
Early stage breast cancer treatment and prognostic factors: Post San Antonio Breast Cancer Symposium 2016.
Christoph Suppan, Marija Balic.
Memo, 2017 Jul 21; 10(2). PMID: 28725276    Free PMC article.
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Are online prediction tools a valid alternative to genomic profiling in the context of systemic treatment of ER-positive breast cancer?
Umar Wazir, Kinan Mokbel, Amtul Carmichael, Kefah Mokbel.
Cell Mol Biol Lett, 2017 Sep 08; 22. PMID: 28878809    Free PMC article.
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Preoperative indication for systemic therapy extended to patients with early-stage breast cancer using multiparametric 7-tesla breast MRI.
A M T Schmitz, W B Veldhuis, +8 authors, K G A Gilhuijs.
PLoS One, 2017 Sep 28; 12(9). PMID: 28949967    Free PMC article.
Large-scale DNA organization is a prognostic marker of breast cancer survival.
Martial Guillaud, Qian Ye, +5 authors, Mira Keyes.
Med Oncol, 2017 Dec 08; 35(1). PMID: 29214466
Prognostic value of tumor-stroma ratio combined with the immune status of tumors in invasive breast carcinoma.
K M H Vangangelt, G W van Pelt, +6 authors, W E Mesker.
Breast Cancer Res Treat, 2017 Dec 24; 168(3). PMID: 29273955    Free PMC article.
Comparison of Residual Risk-Based Eligibility vs Tumor Size and Nodal Status for Power Estimates in Adjuvant Trials of Breast Cancer Therapies.
Wei Wei, Tomoko Kurita, +4 authors, Lajos Pusztai.
JAMA Oncol, 2018 Jan 27; 4(4). PMID: 29372234    Free PMC article.
Spotlight on the utility of the Oncotype DX® breast cancer assay.
Zhen Rong Siow, Richard H De Boer, Geoffrey J Lindeman, G Bruce Mann.
Int J Womens Health, 2018 Mar 06; 10. PMID: 29503586    Free PMC article.
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Prognostic & predictive factors for planning adjuvant chemotherapy of early-stage breast cancer.
Onur Esbah, Berna Oksuzoglu.
Indian J Med Res, 2018 Mar 08; 146(5). PMID: 29512598    Free PMC article.
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Identification of endothelial selectin as a potential prognostic marker in breast cancer.
Wei Zhang, Zhichao Zuo, +3 authors, Danke Su.
Oncol Lett, 2018 Jun 22; 15(6). PMID: 29928363    Free PMC article.
Development and validation of a new predictive model for breast cancer survival in New Zealand and comparison to the Nottingham prognostic index.
J Mark Elwood, Essa Tawfiq, +5 authors, Ross Lawrenson.
BMC Cancer, 2018 Sep 19; 18(1). PMID: 30223800    Free PMC article.
An Update on Breast Cancer Multigene Prognostic Tests-Emergent Clinical Biomarkers.
André Filipe Vieira, Fernando Schmitt.
Front Med (Lausanne), 2018 Sep 21; 5. PMID: 30234119    Free PMC article.
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BCT score predicts chemotherapy benefit in Asian patients with hormone receptor-positive, HER2-negative, lymph node-negative breast cancer.
Mi Jeong Kwon, Sae Byul Lee, +8 authors, Young Kee Shin.
PLoS One, 2018 Nov 22; 13(11). PMID: 30462685    Free PMC article.
Improved survival of older patients with advanced breast cancer due to an increase in systemic treatments: a population-based study.
Nienke de Glas, Esther Bastiaannet, +3 authors, Johanneke Portielje.
Breast Cancer Res Treat, 2019 Jul 22; 178(1). PMID: 31325075    Free PMC article.
Multigene expression signatures in early hormone receptor positive HER 2 negative breast cancer.
Tanja Ovcaricek, Iztok Takac, Erika Matos.
Radiol Oncol, 2019 Sep 26; 53(3). PMID: 31553709    Free PMC article.
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The trans-DATA study: aims and design of a translational breast cancer prognostic marker identification study.
Tim C de Ruijter, Kim M Smits, +7 authors, Vivianne C G Tjan-Heijnen.
Diagn Progn Res, 2019 Oct 24; 3. PMID: 31641693    Free PMC article.
A Nomogram To Predict The Overall Survival Of Breast Cancer Patients And Guide The Postoperative Adjuvant Chemotherapy In China.
Xin Wang, Ziwei Feng, +12 authors, Kexin Chen.
Cancer Manag Res, 2019 Dec 11; 11. PMID: 31819635    Free PMC article.
Decision of Adjuvant Systemic Treatment in HR+ HER2- Early Invasive Breast Cancer: Which Biomarkers Could Help?
Marie Alexandre, Aurélie Maran-Gonzalez, +6 authors, Séverine Guiu.
Cancer Manag Res, 2019 Dec 19; 11. PMID: 31849525    Free PMC article.
Review.
Counseling young women with early breast cancer on fertility preservation.
M E Elena Ter Welle-Butalid, I J H Ingeborg Vriens, +5 authors, V C G Vivianne Tjan-Heijnen.
J Assist Reprod Genet, 2019 Nov 25; 36(12). PMID: 31760547    Free PMC article.
Prognostic DNA methylation markers for hormone receptor breast cancer: a systematic review.
Tim C de Ruijter, Frank van der Heide, +3 authors, Vivianne C G Heijnen.
Breast Cancer Res, 2020 Feb 02; 22(1). PMID: 32005275    Free PMC article.
Systematic Review.
Clinical and Genomic Risk to Guide the Use of Adjuvant Therapy for Breast Cancer.
Joseph A Sparano, Robert J Gray, +27 authors, George W Sledge.
N Engl J Med, 2019 Jun 04; 380(25). PMID: 31157962    Free PMC article.
Highly Cited.
Axillary lymph node dissection in node-positive breast cancer: are ten nodes adequate and when is enough, enough?
Laura H Rosenberger, Yi Ren, +4 authors, Jennifer K Plichta.
Breast Cancer Res Treat, 2019 Nov 20; 179(3). PMID: 31741179    Free PMC article.
Development of tumor mutation burden as an immunotherapy biomarker: utility for the oncology clinic.
T A Chan, M Yarchoan, +4 authors, S Peters.
Ann Oncol, 2018 Nov 06; 30(1). PMID: 30395155    Free PMC article.
Highly Cited. Review.
Facilitating validation of prediction models: a comparison of manual and semi-automated validation using registry-based data of breast cancer patients in the Netherlands.
Cornelia D van Steenbeek, Marissa C van Maaren, +3 authors, Hendrik Koffijberg.
BMC Med Res Methodol, 2019 Jun 10; 19(1). PMID: 31176362    Free PMC article.
Clinical Decision Support Systems in Breast Cancer: A Systematic Review.
Claudia Mazo, Cathriona Kearns, Catherine Mooney, William M Gallagher.
Cancers (Basel), 2020 Feb 12; 12(2). PMID: 32041094    Free PMC article.
Review.
Nomogram Identifies Age as the Most Important Predictor of Overall Survival in Oral Cavity Squamous Cell Cancer After Primary Surgery.
Supriya Gupta, Jennifer Waller, +3 authors, Darko Pucar.
Indian J Otolaryngol Head Neck Surg, 2020 Jun 20; 72(2). PMID: 32551272    Free PMC article.
Chemotherapy in a Breast Cancer Patient Heterozygous Carrier of Ornithine Transcarbamylase Deficiency.
Magda Palka-Kotlowska, Luis Cabezón-Gutiérrez, +2 authors, Silvia Chumillas-Calzada.
Cureus, 2020 Jul 01; 12(5). PMID: 32601573    Free PMC article.
The concordance of treatment decision guided by OncotypeDX and the PREDICT tool in real-world early-stage breast cancer.
Daniel A Goldstein, Chen Mayer, +5 authors, Hadar Goldvaser.
Cancer Med, 2020 May 07; 9(13). PMID: 32372569    Free PMC article.
Compliance with multidisciplinary team recommendations and disease outcomes in early breast cancer patients: An analysis of 4501 consecutive patients.
Xingxia Yang, Jiahui Huang, +3 authors, Xiaosong Chen.
Breast, 2020 Jun 09; 52. PMID: 32512360    Free PMC article.
Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective.
Gouri Shankar Bhattacharyya, Dinesh C Doval, +3 authors, S P Somashekhar.
JCO Glob Oncol, 2020 Jun 09; 6. PMID: 32511068    Free PMC article.
Efficient development and usability testing of decision support interventions for older women with breast cancer.
Kate J Lifford, Adrian Edwards, +10 authors, Kate Brain.
Patient Prefer Adherence, 2019 Jan 27; 13. PMID: 30679905    Free PMC article.
Gene Expression Assays for Early-Stage Hormone Receptor-Positive Breast Cancer: Understanding the Differences.
Ana Tablante Nunes, Deborah E Collyar, Lyndsay N Harris.
JNCI Cancer Spectr, 2017 Dec 11; 1(1). PMID: 31360834    Free PMC article.
Review.
Multidimensional Machine Learning Personalized Prognostic Model in an Early Invasive Breast Cancer Population-Based Cohort in China: Algorithm Validation Study.
Xiaorong Zhong, Ting Luo, +13 authors, Hong Zheng.
JMIR Med Inform, 2020 Nov 10; 8(11). PMID: 33164899    Free PMC article.
Prognostic models for breast cancer: a systematic review.
Minh Tung Phung, Sandar Tin Tin, J Mark Elwood.
BMC Cancer, 2019 Mar 16; 19(1). PMID: 30871490    Free PMC article.
Systematic Review.
Communicating prognosis to women with early breast cancer - overview of prediction tools and the development and pilot testing of a decision aid.
Viktoria Mühlbauer, Birte Berger-Höger, +2 authors, Anke Steckelberg.
BMC Health Serv Res, 2019 Mar 17; 19(1). PMID: 30876414    Free PMC article.
Systematic Review.
Development and internal validation of a predictive risk model for anxiety after completion of treatment for early stage breast cancer.
Jenny Harris, Edward Purssell, +3 authors, Jo Armes.
J Patient Rep Outcomes, 2020 Dec 05; 4(1). PMID: 33275165    Free PMC article.
Concordance between results of inexpensive statistical models and multigene signatures in patients with ER+/HER2- early breast cancer.
Laurence Slembrouck, Isabelle Vanden Bempt, +12 authors, Giuseppe Floris.
Mod Pathol, 2021 Feb 10;. PMID: 33558657
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.
Paolo Giorgi Rossi, Annette Lebeau, +13 authors, ECIBC Contributor Group.
Br J Cancer, 2021 Feb 19;. PMID: 33597715
Review.