title: Development of a model to predict breast cancer survival using data from the National Cancer Data Base.
abstract: BACKGROUND
  With the large amounts of data on patient, tumor, and treatment factors available to clinicians, it has become critically important to harness this information to guide clinicians in discussing a patient's prognosis. However, no widely accepted survival calculator is available that uses national data and includes multiple prognostic factors. Our objective was to develop a model for predicting survival among patients diagnosed with breast cancer using the National Cancer Data Base (NCDB) to serve as a prototype for the Commission on Cancer's "Cancer Survival Prognostic Calculator."
  
  
  METHODS
  A retrospective cohort of patients diagnosed with breast cancer (2003-2006) in the NCDB was included. A multivariable Cox proportional hazards regression model to predict overall survival was developed. Model discrimination by 10-fold internal cross-validation and calibration was assessed.
  
  
  RESULTS
  There were 296,284 patients for model development and internal validation. The c-index for the 10-fold cross-validation ranged from 0.779 to 0.788 after inclusion of all available pertinent prognostic factors. A plot of the observed versus predicted 5 year overall survival showed minimal deviation from the reference line.
  
  
  CONCLUSIONS
  This breast cancer survival prognostic model to be used as a prototype for building the Commission on Cancer's "Cancer Survival Prognostic Calculator" will offer patients and clinicians an objective opportunity to estimate personalized long-term survival based on patient demographic characteristics, tumor factors, and treatment delivered.
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, IL; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address: easare@facs.org.
authors.forename: Elliot A
authors.initials: EA
authors.lastname: Asare
authors.affiliation: Department of Preventive Medicine-Biostatistics, Northwestern University, Chicago, IL.
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Hess
authors.affiliation: Center for Healthcare Studies and Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
authors.affiliation: Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Paruch
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, IL.
authors.forename: Bryan
authors.initials: B
authors.lastname: Palis
authors.affiliation: Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc) and Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Allison R
authors.initials: AR
authors.lastname: Dahlke
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, IL.
authors.forename: Ryan
authors.initials: R
authors.lastname: McCabe
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, IL.
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.affiliation: Cancer Programs, American College of Surgeons, Chicago, IL; Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc) and Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality*; D018275:Carcinoma, Lobular / Q000401:mortality*; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult