title: Validation of the CancerMath prognostic tool for breast cancer in Southeast Asia.
abstract: CancerMath is a set of web-based prognostic tools which predict nodal status and survival up to 15 years after diagnosis of breast cancer. This study validated its performance in a Southeast Asian setting.
  
  
  
  Using Singapore Malaysia Hospital-Based Breast Cancer Registry, clinical information was retrieved from 7064 stage I to III breast cancer patients who were diagnosed between 1990 and 2011 and underwent surgery. Predicted and observed probabilities of positive nodes and survival were compared for each subgroup. Calibration was assessed by plotting observed value against predicted value for each decile of the predicted value. Discrimination was evaluated by area under a receiver operating characteristic curve (AUC) with 95 % confidence interval (CI).
  
  
  
  The median predicted probability of positive lymph nodes is 40.6 % which was lower than the observed 43.6 % (95 % CI, 42.5 %-44.8 %). The calibration plot showed underestimation for most of the groups. The AUC was 0.71 (95 % CI, 0.70-0.72). Cancermath predicted and observed overall survival probabilities were 87.3 % vs 83.4 % at 5 years after diagnosis and 75.3 % vs 70.4 % at 10 years after diagnosis. The difference was smaller for patients from Singapore, patients diagnosed more recently and patients with favorable tumor characteristics. Calibration plot also illustrated overprediction of survival for patients with poor prognosis. The AUC for 5-year and 10-year overall survival was 0.77 (95 % CI: 0.75-0.79) and 0.74 (95 % CI: 0.71-0.76).
  
  
  
  The discrimination and calibration of CancerMath were modest. The results suggest that clinical application of CancerMath should be limited to patients with better prognostic profile.
authors: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore. ephmh@nus.edu.sg.
authors: Hui
authors: H
authors: Miao
authors: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Singapore.|Department of Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77, Stockholm, Sweden.
authors: Mikael
authors: M
authors: Hartman
authors: Imaging Division, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
authors: Helena M
authors: HM
authors: Verkooijen
authors: Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors: Nur Aishah
authors: NA
authors: Taib
authors: Clinical Epidemiology Unit, National Clinical Research Centre, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors: Hoong-Seam
authors: HS
authors: Wong
authors: Clinical Epidemiology Unit, National Clinical Research Centre, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors: Shridevi
authors: S
authors: Subramaniam
authors: Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors: Cheng-Har
authors: CH
authors: Yip
authors: Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
authors: Ern-Yu
authors: EY
authors: Tan
authors: Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
authors: Patrick
authors: P
authors: Chan
authors: Department of Hematology Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
authors: Soo-Chin
authors: SC
authors: Lee
authors: Clinical Epidemiology Unit, National Clinical Research Centre, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.|Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.|Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85500, 3508, AB, Utrecht, The Netherlands.
authors: Nirmala
authors: N
authors: Bhoo-Pathy
mesh_terms: D019540:Area Under Curve; D001210:Asia, Southeastern / Q000453:epidemiology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D011379:Prognosis; D012042:Registries
keywords: Asia; Breast cancer; CancerMath; Prognostic model