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Direct comparison of three different mathematical models in two independent datasets of EUSOMA certified centers to predict recurrence and survival in estrogen receptor-positive breast cancer: impact on clinical practice

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Abstract

Purpose

Prediction algorithms estimating survival rates for breast cancer (BC) based upon risk factors and treatment could give a help to the clinicians during multidisciplinary meetings. The aim of this study was to evaluate accuracy and clinical utility of three different scores: the Clinical Treatment Score Post-5 Years (CTS5), the PREDICT Score, and the Nottingham Prognostic Index (NPI).

Methods

This is a retrospective cohort analysis conducted on prospectively recorded databases of two EUSOMA certified centers (Breast Unit of Trieste Academic Hospital and of Cremona Hospital, Italy). We included patients with Luminal BC undergone to breast surgery between 2010 and 2015, and subsequent endocrine therapy for 5 years for curative intent.

Results

A total of 473 patients were enrolled in this study. ROC analysis showed fair accuracy for NPI, good accuracy for PREDICT, and optimal accuracy for CTS5 (AUC 0.7, 0.76, and 0.83, respectively). The three scores seemed strongly correlated in Spearman’s rank correlation coefficient analysis. PREDICT partially overestimated OS in patients undergone to mastectomy, and in pT3-4, G3 tumors. Considering DRFS as a surrogate of OS, CTS5 showed women in intermediate and high risk class had shorter OS too (respectively p = 0.001 and p < 0.001). Combining scores does not improve prognostication power.

Conclusion

Mathematical models may help clinicians in decision making (adjuvant therapies, CDK4/6i, genomic test’s gray zones). CTS5 has the higher prognostic accuracy in predicting recurrence, while score predicting OS did not show substantial advances, proving that pN, G, and pT are still the most important variables in predicting OS.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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Funding

The authors certify that they have no affiliations or involvement in any organization or entity with financial interest (honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership, or other equity interest, and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. The manuscript has not and will not be a podium or poster meeting presentation.

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Authors and Affiliations

  1. Department of General Surgery, Academic Hospital of Trieste, Trieste University Hospital, Strada di Fiume 447, 34149, Trieste, Italy

    Cristiana Iacuzzo

  2. Department of Medicine, Surgery and Health Sciences, University of Trieste, Biostatistics Unit, Trieste, Italy

    Fabiola Giudici

  3. Epidemiology and Public Health Department, University of Padua, Biostatistics Unit, Padua, Italy

    Fabiola Giudici

  4. Breast Unit, Academic Hospital of Trieste, Trieste, Italy

    Serena Scomersi, Rita Ceccherini, Fabrizio Zanconati & Marina Bortul

  5. Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy

    Daniele Generali

  6. Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy

    Daniele Generali

Authors
  1. Cristiana Iacuzzo
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  2. Fabiola Giudici
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  3. Serena Scomersi
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  4. Rita Ceccherini
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  5. Fabrizio Zanconati
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  6. Daniele Generali
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  7. Marina Bortul
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Contributions

All the authors gave their own contribution to the design, statistical analysis, and writing of the manuscript.

Corresponding author

Correspondence to Cristiana Iacuzzo.

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The authors do not have interests to disclose.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent by the institutional research committee is not required in Italy.

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Informed consent was obtained from all the participants included.

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Iacuzzo, C., Giudici, F., Scomersi, S. et al. Direct comparison of three different mathematical models in two independent datasets of EUSOMA certified centers to predict recurrence and survival in estrogen receptor-positive breast cancer: impact on clinical practice. Breast Cancer Res Treat 187, 455–465 (2021). https://doi.org/10.1007/s10549-021-06144-4

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  • DOI: https://doi.org/10.1007/s10549-021-06144-4

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