Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years

Ellen G. Engelhardt, Alexandra J. van den Broek, Sabine C. Linn, Gordon C. Wishart, Emiel J. Th. Rutgers, Anthonie O. van de Velde, Vincent T. H. B. M. Smit, Adri C. Voogd, Sabine Siesling, Mariel Brinkhuis, Caroline Seynaeve, Pieter J. Westenend, Anne M. Stiggelbout, Rob A. E. M. Tollenaar, Flora E. van Leeuwen, Laura J. van 't Veer, Peter M. Ravdin, Paul D. P. Pharaoh, Marjanka K. Schmidt*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Importance: Online prognostication tools such as PREDICT and Adjuvant! are increasingly used in clinical practice by oncologists to inform patients and guide treatment decisions about adjuvant systemic therapy. However, their validity for young breast cancer patients is debated.

Objective: To assess first, the prognostic accuracy of PREDICT's and Adjuvant! 10-year all-cause mortality, and second, its breast cancer-specific mortality estimates, in a large cohort of breast cancer patients diagnosed

Design: Hospital-based cohort.

Setting: General and cancer hospitals.

Participants: A consecutive series of 2710 patients without a prior history of cancer, diagnosed between 1990 and 2000 with unilateral stage I-III breast cancer aged

Main outcome measures: Calibration and discriminatory accuracy, measured with C-statistics, of estimated 10-year all-cause and breast cancer-specific mortality.

Results: Overall, PREDICT's calibration for all-cause mortality was good (predicted versus observed) mean(difference): -1.1% (95% CI: -3.2%-0.9%; P=0.28). PREDICT tended to under-estimate all-cause mortality in good prognosis subgroups (range mean(difference): -2.9% to -4.8%), overestimated all-cause mortality in poor prognosis subgroups (range mean(difference): 2.6%-9.4%) and underestimated survival in patients

Conclusions: Although imprecise at the extremes, PREDICT's estimates of 10-year all-cause mortality seem reasonably sound for breast cancer patients

Original languageEnglish
Pages (from-to)37-44
Number of pages8
JournalEuropean Journal of Cancer
Publication statusPublished - Jun 2017


  • Breast cancer
  • Young patients
  • Prognostication tool
  • Adjuvant
  • Prognostic accuracy
  • AGE
  • RISK
  • HER2

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