title: Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Sanghani
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.forename: Rita Abi
authors.initials: RA
authors.lastname: Raad
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.forename: Mary
authors.initials: M
authors.lastname: Lesperance
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
authors.forename: David E
authors.initials: DE
authors.lastname: Wazer
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D001955:British Columbia; D019992:Databases as Topic; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D020407:Internet; D053208:Kaplan-Meier Estimate; D015412:Mastectomy, Segmental; D008875:Middle Aged; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local; D049451:Nomograms; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States