title: Adjuvant! Online is overoptimistic in predicting survival of Asian breast cancer patients.
abstract: BACKGROUND
  Adjuvant! Online is a free web-based tool which predicts 10-year breast cancer outcomes and the efficacy of adjuvant therapy in patients with breast cancer. As its prognostic performance has only been validated in high income Caucasian populations, we validated the model in a middle income Asian setting.
  
  
  METHODS
  Within the University Malaya Hospital-Based Breast Cancer Registry, all 631 women who were surgically treated for invasive non-metastatic breast cancer between 1993 and 2000 were identified. The discriminative performance of Adjuvant! Online was tested using receiver operating characteristic (ROC) analysis. Calibration of the model was evaluated by comparing predicted 10-year overall survival with observed 10-year survival.
  
  
  RESULTS
  Adjuvant! Online was fairly capable in discriminating between good and poor survivors, as attested by the area under ROC curve of 0.73 (95% Confidence Interval: 0.69-0.77). Overall, Adjuvant! Online predicted 10 year survival (70.3%) was significantly higher than the observed 10 year survival (63.6%, difference of 6.7%; 95% CI: 3.0-10.4%). The model was especially overoptimistic in women under 40 years and in women of Malay ethnicity, where survival was overestimated by approximately 20% (95% CI: 9.8-29.8%) and 15% (95% CI: 5.3-24.5%) respectively.
  
  
  CONCLUSIONS
  Even though Adjuvant! Online is capable of discriminating between good and poor survivors, it systematically overestimates survival. These findings suggest that the model requires adaptation prior to use in Asian settings.
authors.affiliation: National Clinical Research Centre, Level 3, Dermatology Block, Kuala Lumpur Hospital, 50586 Jalan Pahang, Kuala Lumpur, Malaysia.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Bhoo-Pathy
authors.forename: Cheng-Har
authors.initials: CH
authors.lastname: Yip
authors.forename: Mikael
authors.initials: M
authors.lastname: Hartman
authors.forename: Nakul
authors.initials: N
authors.lastname: Saxena
authors.forename: Nur Aishah
authors.initials: NA
authors.lastname: Taib
authors.forename: Gwo-Fuang
authors.initials: GF
authors.lastname: Ho
authors.forename: Lai-Meng
authors.initials: LM
authors.lastname: Looi
authors.forename: Awang M
authors.initials: AM
authors.lastname: Bulgiba
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008296:Malaysia; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant