Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011;6(11):e27446.
doi: 10.1371/journal.pone.0027446. Epub 2011 Nov 8.

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

David Hajage  1 , Yann de Rycke, Marc Bollet, Alexia Savignoni, Martial Caly, Jean-Yves Pierga, Hugo M Horlings, Marc J Van de Vijver, Anne Vincent-Salomon, Brigitte Sigal-Zafrani, Claire Senechal, Bernard Asselain, Xavier Sastre, Fabien Reyal
Affiliations

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

David Hajage et al. PLoS One. 2011.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Mean predicted versus observed survival.
French population. The data were divided into 5% intervals for the predicted values. Observed percentages were calculated for each interval subset and were plotted against the average predicted values. The grey thin line of slope = 1 and intercept = 0 corresponds to a perfect agreement between observed and predicted values.
Figure 2
Figure 2. Mean predicted versus observed survival.
Dutch population. The data were divided into 5% intervals for the predicted values. Observed percentages were calculated for each interval subset and were plotted against the average predicted values. The thin line of slope = 1 and intercept = 0 corresponds to a perfect agreement between observed and predicted values.
Figure 3
Figure 3. Difference (Δ) between observed outcome and Adjuvant! Online prediction in three other major confirmation studies , , .
See this image and copyright information in PMC

References

    1. Blamey RW, Davies CJ, Elston CW, Johnson J, Haybittle JL, et al. Prognostic factors in breast cancer – the formation of a prognostic index. Clin Oncol. 1979;5:227–236. - PubMed
    1. Haybittle JL, Blamey RW, Elston CW, Johnson J, Doyle PJ, et al. A prognostic index in primary breast cancer. Br J Cancer. 1982;45:361–366. - PMC - PubMed
    1. Todd JH, Dowle C, Williams MR, Elston CW, Ellis IO, et al. Confirmation of a prognostic index in primary breast cancer. Br J Cancer. 1987;56:489–492. - PMC - PubMed
    1. Ravdin PM, Siminoff LA, Davis GJ, Mercer MB, Hewlett J, et al. Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol. 2001;19:980–991. - PubMed
    1. Early Breast Cancer Trialists' Collaborative Group. Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group. Lancet. 1998;352:930–942. - PubMed

Publication types