Limited value of the online Adjuvant! program in older breast cancer patients
Glas, N.A. de, Water, W. van de, Engelhardt, E.G., Bastiaannet, E., Craen, A.J.M. de, Kroep, J.R., Putter, H., Stiggelbout, A.M., Weijl, N.I., Velde, C.J.H. van de, Portielje, J.E.A., Liefers, G.J.
Voorzitter(s): prof.dr. R.P. Koopmans, Maastricht & dr. F.L.G. Erdkamp, Geleen
Locatie(s): Zaal 2.7/2.8
Categorie(ën):
Introduction: Adjuvant! Online is a prediction tool that can be used to aid clinical decision making in breast cancer patients. Both the Dutch Guidelines as well as the recommendations of the International Society of Geriatric Oncology advise to use Adjuvant! Online for adjuvant treatment decisions in older breast cancer patients specifically. However, Adjuvant! Online was developed in a relatively young population, and validation studies included small numbers of older patients.
Aim of the study: Since older breast cancer patients differ from younger patients in many aspects, the aim of this study was to investigate the validity of Adjuvant! Online in a large and unselected cohort of older breast cancer patients.
Materials and Methods: We included patients from the population-based FOCUS cohort, which comprises all incident breast cancer patients aged 65 years or older diagnosed in the geographically defined Comprehensive Cancer Center Region West in The Netherlands between January 1997 and December 2004. Predicted 10-year overall survival and cumulative recurrence rates were compared with observed 10-year OS and CR using one-sample T-tests. Discriminatory accuracy was tested by composing ROC-curves and calculating corresponding c-indices; calibration was tested using Poisson regression models.
Results: Overall 2,012 patients were included. Predicted and observed 10-year overall survival strongly differed (48·8% versus 39·0%, difference 9·8, 95% Confidence Interval (CI) 5·9 to 13·7, p<0·001), as did 10-year cumulative recurrence (predicted 26·9%, observed 18·2%, difference 8·7, 95% CI 6·7 to 10·7, p<0·001). The discriminatory accuracy of Adjuvant! Online was moderate for overall survival (C-index 0·75, 95% CI 0·72 to 0·77, p<0·001) and poor for cumulative recurrence (C-index 67, 95% CI 0·65-0·71, p<0·001), as was calibration (p<0·001 for both overall survival and cumulative recurrence).
Conclusion: Adjuvant! Online does not accurately predict overall survival and recurrence in older breast cancer patients and should be interpreted with caution. This is in sharp contrast with current guidelines and recommendations in which use of Adjuvant! Online is recommended in older patients. Improved prediction tools are needed in this growing group of older breast cancer patients, thereby individualizing clinical decision making and optimizing outcome.
- Over Glas, N.A. de
- Over Water, W. van de
- Over Engelhardt, E.G.
- Over Bastiaannet, E.
- Over Craen, A.J.M. de
- Over Kroep, J.R.
- Over Putter, H.
- Over Stiggelbout, A.M.
- Over Weijl, N.I.
- Over Velde, C.J.H. van de
- Over Portielje, J.E.A.
- Over Liefers, G.J.