Abstract
Background
Adjuvant! Online (AOL) is a Web-accessible risk-assessment model that predicts the mortality and the benefits of adjuvant therapy for breast cancer.
Methods
Using the Yonsei Tumor Registry database, patients with T1–3, N0–3, M0 breast cancer who were treated at the Yonsei Cancer Center between 1986 and 1999 were entered into AOL version 8.0 to calculate survival.
Results
The median age of the study population was 45 years (range, 23–76 years) and the median follow-up duration was 10.8 years (range, 0.1–25.9 years) for all 699 patients. AOL significantly overestimated overall survival (OS) (by 11.1 %, P < 0.001), breast cancer-specific survival (BCSS) (by 11.6 %, P < 0.001), and event free-free survival (EFS) (by 9.25 %, P < 0.001) in Korean patients. Therefore, we developed a Korean version of AOL (KAOL), which is a new model for prognosis based on AOL’s parameters. The observed 10-year OS (61.4 %), BCSS (62.3 %), and EFS (59.1 %) and the KAOL predicted OS (61.5 %), BCSS (63.5 %) and EFS (57.6 %) were not different (P = 0.976, P = 0.771, and P = 0.674, respectively).
Conclusions
AOL was not found to be suitable in Korean patients with breast cancer. The newly developed KAOL accurately predicted 10-year outcomes in Korean breast cancer patients.
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References
Eifel P, Axelson JA, et al; National Institutes of Health Consensus Development Panel. National Institutes of Health Consensus Development Conference Statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst. 2001;93:979–89.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717.
Goldhirsch A, Glick JH, Gelber RD, Coates AS, Senn HJ. Meeting highlights: International consensus panel on the treatment of primary breast cancer. Seventh international conference on adjuvant therapy of primary breast cancer. J Clin Oncol. 2001;19:3817–27.
Galea MH, Blamey RW, Elston CE, Ellis IO. The Nottingham prognostic index in primary breast cancer. Breast Cancer Res Treat. 1992;22:207–19.
Ravdin PM, Siminoff LA, Davis GJ, et al. Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol. 2001;19:980–91.
Olivotto IA, Bajdik CD, Ravdin PM, et al. Population-based validation of the prognostic model Adjuvant! for early breast cancer. J Clin Oncol. 2005;23:2716–25.
Mook S, Schmidt MK, Rutgers EJ, et al. Calibration and discriminatory accuracy of prognosis calculation for breast cancer with the online Adjuvant! program: a hospital-based retrospective cohort study. Lancet Oncol. 2009;10:1070–6.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24:2137–50.
Porter P. “Westernizing” women’s risks? Breast cancer in lower-income countries. N Engl J Med. 2008;358:213–6.
Yoo KY, Kang D, Park SK, et al. Epidemiology of breast cancer in Korea: occurrence, high-risk groups, and prevention. J Korean Med Sci. 2002;17:1–6.
Shin HR, Won YJ, Jung KW, et al. Nationwide cancer incidence in Korea, 1999–2001: first result using the national cancer incidence database. Cancer Res Treat. 2005;37:325–31.
Lee TH, Paik NS, Kim YK. Carcinoma of the breast in women 35 years of age or less. Cancer Res Treat. 1992;24:834–9.
Jeong J. Korean Breast Cancer Society. Nationwide Korean breast cancer data of 2004 using breast cancer registration program. J Breast Cancer. 2006;9:151–61.
Ries LAG, Melbert D, Krapcho M, et al.: SEER cancer statistics review, 1975–2004. http://seer.cancer.gov/csr/1975_2004/ (2007). Accessed 1 June 2009.
Agarwal G, Pradeep PV, Aggarwal V, Yip C, Cheung PS. Spectrum of breast cancer in Asian women. World J Surg. 2007;31:1031–40.
Jung M, Shin HJ, Rha SY, et al. The clinical outcome of chemotherapy-induced amenorrhea in premenopausal young patients with breast cancer with long-term follow-up. Ann Surg Oncol. 2010;17:3259–68.
Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.
Klein JP, Moeschberger ML. Survival analysis: techniques for censored and truncated data. 2nd ed. New York: Springer; 2003.
Agresti A. An introduction to categorical data analysis. 2nd ed. Hoboken: Wiley; 2007.
Campbell HE, Taylor MA, Harris AL, Gray AM. An investigation into the performance of the Adjuvant! Online prognostic programme in early breast cancer for a cohort of patients in the United Kingdom. Br J Cancer. 2009;101:1074–84.
Han W, Ko S, Jeong J, et al. Poor outcome of hormone receptor-positive breast cancer at very young age is due to tamoxifen resistance: nationwide survival data in Korea—a report from the Korean Breast Cancer Society. J Clin Oncol. 2007;25:2360–8.
Goldhirsch A, Coates AS, Werner ID, et al. Is chemotherapy alone adequate for young women with oestrogen-receptor-positive breast cancer? Lancet. 2000;355:1869–74.
Tan BK, Lim GH, Czene K, Hall P, Chia KS. Do Asian breast cancer patients have poorer survival than their western counterparts? A comparison between Singapore and Stockholm. Breast Cancer Res. 2009;11:R4.
Lim S, Back M, Quek E, Iau P, Putti T, Wong JE. Clinical observations from a breast cancer registry in Asian women. World J Surg. 2007;31:1387–92.
Chu KC, Anderson WF, Fritz A, Ries LA, Brawley OW. Frequency distributions of breast cancer characteristics classified by estrogen receptor and progesterone receptor status for eight racial/ethnic groups. Cancer. 2001;92:37–45.
Chow LW, Ho P. Hormonal receptor determination of 1,052 Chinese breast cancers. J Surg Oncol. 2000;75:172–5.
Chuang E, Christos P, Flam A, et al. Breast cancer subtypes in Asian-Americans differ according to Asian ethnic group. J Immigr Minor Health. 2012;14(5):754–8.
Telli ML, Chang ET, Kurian AW, et al. Asian ethnicity and breast cancer subtypes: a study from the California Cancer Registry. Breast Cancer Res Treat. 2011;127:471–8.
Bhoo Pathy N, Yip C, Hartman M, et al. Adjuvant! Online is overoptimistic in predicting survival of Asian breast cancer patients. Eur J Cancer. 2012;48:982–9.
Acknowledgment
This work was supported in part by the Korea Science and Engineering Fund (KOSEF) through the Cancer Metastasis Research Center (CMRC) at Yonsei University College of Medicine. (R11-2000-082-03002-0.)
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The authors declare no conflict of interest.
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Jung, M., Choi, E.H., Nam, C.M. et al. Application of the Adjuvant! Online Model to Korean Breast Cancer Patients: An Assessment of Prognostic Accuracy and Development of an Alternative Prognostic Tool. Ann Surg Oncol 20, 2615–2624 (2013). https://doi.org/10.1245/s10434-013-2956-z
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DOI: https://doi.org/10.1245/s10434-013-2956-z