Document Detail

Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy.
MedLine Citation:
PMID:  20048188     Owner:  NLM     Status:  MEDLINE    
PURPOSE IBTR! version 1.0 is a web-based tool that uses literature-derived relative risk ratios for seven clinicopathologic variables to predict ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT). Preliminary testing demonstrated over-estimation in high-risk subgroups. This study uses two independent population-based datasets to create and validate a modified nomogram, IBTR! version 2.0. METHODS Cox regression modeling was performed on 7,811 patients treated with BCT at the British Columbia Cancer Agency (median follow-up, 9.4 years). Population-based hazard ratios were generated for the seven variables in the original nomogram. A modified nomogram was then tested against 664 patients from Massachusetts General Hospital (median follow-up, 9.3 years). The mean predicted and observed 10-year estimates were compared for the entire cohort and for four groups predefined by nomogram-predicted risks: group 1: less than 3%; group 2: 3% to 5%; group 3: 5% to 10%; and group 4: more than 10%. Results IBTR! version 2.0 predicted an overall 10-year IBTR estimate of 4.0% (95% CI, 3.8 to 4.2), while the observed estimate was 2.8% (95% CI, 1.6 to 4.7; P = .10). The predicted and observed IBTR estimates were: group 1 (n = 283): 2.2% versus 1.3%, P = .40; group 2 (n = 237): 3.8% versus 3.5%, P = .80; group 3 (n = 111): 6.7% versus 3.2%, P = .05; and group 4 (n = 33): 12.5% versus 8.7%, P = .50. CONCLUSION IBTR! version 2.0 is accurate in the majority of patients with a low to moderate risk of in-breast recurrence. The nomogram still overestimates risk in a minority of patients with higher risk features. Validation in a larger prospective data set is warranted.
Mona Sanghani; Pauline T Truong; Rita Abi Raad; Andrzej Niemierko; Mary Lesperance; Ivo A Olivotto; David E Wazer; Alphonse G Taghian
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2010-01-04
Journal Detail:
Title:  Journal of clinical oncology : official journal of the American Society of Clinical Oncology     Volume:  28     ISSN:  1527-7755     ISO Abbreviation:  J. Clin. Oncol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-09     Completed Date:  2010-03-04     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  718-22     Citation Subset:  IM    
Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
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MeSH Terms
Breast Neoplasms / pathology,  radiotherapy,  surgery*
British Columbia
Databases as Topic
Decision Support Techniques*
Kaplan-Meier Estimate
Mastectomy, Segmental*
Middle Aged
Models, Biological*
Neoplasm Recurrence, Local*
Predictive Value of Tests
Proportional Hazards Models
Radiotherapy, Adjuvant
Reproducibility of Results
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Grant Support
Comment In:
J Clin Oncol. 2010 Feb 10;28(5):709-11   [PMID:  20048173 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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