Abstract
IntroductionThe aim of this study was to develop and validate a prognostication model to predict overall and breast cancer specific survival for women treated for early breast cancer in the UK.MethodsUsing the Eastern Cancer Registration and Information Centre (ECRIC) dataset, information was collated for 5,694 women who had surgery for invasive breast cancer in East Anglia from 1999 to 2003. Breast cancer mortality models for oestrogen receptor (ER) positive and ER negative tumours were derived from these data using Cox proportional hazards, adjusting for prognostic factors and mode of cancer detection (symptomatic versus screen-detected). An external dataset of 5,468 patients from the West Midlands Cancer Intelligence Unit (WMCIU) was used for validation.ResultsDifferences in overall actual and predicted mortality were <1% at eight years for ECRIC (18.9% vs. 19.0%) and WMCIU (17.5% vs. 18.3%) with area under receiver-operator-characteristic curves (AUC) of 0.81 and 0.79 respectively. Differences in breast cancer specific actual and predicted mortality were <1% at eight years for ECRIC (12.9% vs. 13.5%) and <1.5% at eight years for WMCIU (12.2% vs. 13.6%) with AUC of 0.84 and 0.82 respectively. Model calibration was good for both ER positive and negative models although the ER positive model provided better discrimination (AUC 0.82) than ER negative (AUC 0.75).ConclusionsWe have developed a prognostication model for early breast cancer based on UK cancer registry data that predicts breast cancer survival following surgery for invasive breast cancer and includes mode of detection for the first time. The model is well calibrated, provides a high degree of discrimination and has been validated in a second UK patient cohort.
Highlights
The aim of this study was to develop and validate a prognostication model to predict overall and breast cancer specific survival for women treated for early breast cancer in the UK
The Nottingham Prognostic Index (NPI), a prognostic scoring system based on a large cohort of patients with early breast cancer treated in a single institution, is based on tumour size, grade and lymph node status and when first described divided patients into three groups with significantly different survival [1]
Breast cancer specific survival (BCSS) without adjuvant therapy was calculated based on estimates of the number of patients likely to have received systemic therapy and the risk reductions outlined in the Early Breast Cancer Trialists' Collaborative Group [7,8]
Summary
Breast cancer specific survival (BCSS) without adjuvant therapy was calculated based on estimates of the number of patients likely to have received systemic therapy and the risk reductions outlined in the Early Breast Cancer Trialists' Collaborative Group [7,8]. These assumptions have been validated in a population-based Canadian dataset [9] there has always been some uncertainty about how applicable the Adjuvant! A recent paper has shown that Adjuvant! overestimated the overall survival by 6% in a UK cohort of 1,065 women with early breast cancer treated in Oxford between 1986 and 1996 [10]
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