Journal of Clinical Oncology, Vol 1, 776-786, Copyright © 1983 by American Society of Clinical Oncology
Multivariate analysis of prognostic factors in metastatic breast cancer
GN Hortobagyi, TL Smith, SS Legha, KD Swenerton, EA Gehan, HY Yap, AU Buzdar and GR Blumenschein
Univariate and multivariate analyses were conducted on data collected from
the records of 619 patients with metastatic breast cancer in whom an
Adriamycin-containing chemotherapeutic regimen was used. Using a forward,
stepwise logistic regression procedure, several models or equations in
which a small number of pretreatment factors were incorporated were
generated and the probability of response to therapy was accurately
predicted. The predictive ability of these models was tested
retrospectively in 546 of the 619 patients from whom the data were derived
and prospectively in a new population of 200 patients with metastatic
breast cancer also treated with a therapeutically equivalent Adriamycin
combination. Using similar univariate techniques, pretreatment factors were
correlated with the length of survival after therapy. The proportional
hazard model of Cox was used to develop a regression model relating
survival to pretreatment characteristics in much the same manner as that of
the response model. The total population of the initial group of patients
was divided according to four levels of hazard ratio, and survival
distributions were compared. This model also was tested progressively and
its predictive capability was confirmed. The prediction of individual
outcome is a valuable capability in the comparison of clinical trials and
the continuing evaluation of biologic changes in patients with metastatic
carcinoma; such a method is described in this paper.
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