A tool for predicting breast carcinoma mortality in women who do not receive adjuvant therapy Journal Article


Authors: Kattan, M. W.; Giri, D.; Panageas, K. S.; Hummer, A.; Cranor, M.; Van Zee, K. J.; Hudis, C. A.; Norton, L.; Borgen, P. I.; Tan, L. K.
Article Title: A tool for predicting breast carcinoma mortality in women who do not receive adjuvant therapy
Abstract: BACKGROUND. Among the several proposed risk classification schemes for predicting survival in women with breast carcinoma, one of the most commonly used is the Nottingham Prognostic Index (NPI). The goal of the current study was to use a continuous prognostic model (similar to those that have already been demonstrated to possess greater predictive accuracy than risk group-based models in other malignancies) to predict breast carcinoma mortality more accurately compared with the NPI. METHODS. A total of 519 women who had been treated with mastectomy and axillary lymph node dissection at Memorial Sloan-Kettering Cancer Center (New York, NY) between 1976 and 1979 met the following requirements for study inclusion: confirmation of the presence of invasive mammary carcinoma, no receipt of neoadjuvant or adjuvant systemic therapy, no previous history of malignancy, and negative lymph node status as assessed on routine histopathologic examination. Paraffin blocks were available for 368 of the 519 eligible patients. All available axillary lymph node tissue blocks were subjected to enhanced pathologic analysis. The competing-risk method was used to predict disease-specific death, and the accuracy of the novel prognostic model that emerged from this process was evaluated using the concordance index. Jackknife and 10-fold cross-validation predictions yielded by this new model were compared with predictions yielded by the NPI. RESULTS. Of the 348 women for whom complete data were available, 73 died of disease; the 15-year probability of breast carcinoma-related death was 20%. On the basis of these 348 cases, the authors developed a prognostic model that took patient age, disease multifocality, tumor size, tumor grade, lymphovascular invasion, and enhanced lymph node staining into account, and using competing-risks regression analysis, they found that this new model predicted disease-specific death more accurately compared with the NPI. CONCLUSIONS. The authors have developed a model for predicting breast carcinoma-specific death with improved accuracy. This tool should be useful in counseling patients with regard to their specific need for adjuvant therapy. © 2004 American Cancer Society.
Keywords: immunohistochemistry; adult; cancer survival; human tissue; aged; aged, 80 and over; middle aged; major clinical study; cancer adjuvant therapy; lymphatic metastasis; neoplasm staging; cancer grading; lymph node excision; cohort studies; mastectomy; tumor volume; age factors; breast neoplasms; prediction; cancer mortality; risk assessment; models, theoretical; probability; lymph node; breast carcinoma; carcinoma; forecasting; multiple cancer; nomogram; modeling; humans; prognosis; human; male; female; priority journal; article; nottingham prognostic index
Journal Title: Cancer
Volume: 101
Issue: 11
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2004-12-01
Start Page: 2509
End Page: 2515
Language: English
DOI: 10.1002/cncr.20635
PROVIDER: scopus
PUBMED: 15495180
DOI/URL:
Notes: Cancer -- Cited By (since 1996):24 -- Export Date: 16 June 2014 -- CODEN: CANCA -- Source: Scopus
Altmetric
Citation Impact
MSK Authors
  1. Amanda J Hummer
    60 Hummer
  2. Clifford Hudis
    904 Hudis
  3. Larry Norton
    734 Norton
  4. Lee K Tan
    145 Tan
  5. Kimberly J Van Zee
    289 Van Zee
  6. Dilip D Giri
    180 Giri
  7. Patrick I Borgen
    253 Borgen
  8. Katherine S Panageas
    482 Panageas
  9. Milicent Cranor
    48 Cranor
  10. Michael W Kattan
    218 Kattan