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.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. kattanm@ccf.org
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Dilip
authors.initials: D
authors.lastname: Giri
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Panageas
authors.forename: Amanda
authors.initials: A
authors.lastname: Hummer
authors.forename: Milicent
authors.initials: M
authors.lastname: Cranor
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Van Zee
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.forename: Larry
authors.initials: L
authors.lastname: Norton
authors.forename: Patrick I
authors.initials: PI
authors.lastname: Borgen
authors.forename: Lee K
authors.initials: LK
authors.lastname: Tan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D011379:Prognosis; D018570:Risk Assessment