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Journal of Clinical Oncology, Vol 23, No 12 (April 20), 2005: pp. 2716-2725
© 2005 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2005.06.178
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Population-Based Validation of the Prognostic Model ADJUVANT! for Early Breast Cancer

Ivo A. Olivotto, Chris D. Bajdik, Peter M. Ravdin, Caroline H. Speers, Andrew J. Coldman, Brian D. Norris, Greg J. Davis, Stephen K. Chia, Karen A. Gelmon

From the Breast Cancer Outcomes Unit, Radiation, Medical, and Population and Preventive Oncology Programs, the Vancouver Island, Vancouver, and Fraser Valley Centres of the British Columbia Cancer Agency; the University of British Columbia, Victoria, Vancouver, and Surrey, British Columbia, Canada; and The University of Texas Health Sciences Center, San Antonio, TX

Address reprint requests to Ivo A. Olivotto, MD, Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver Island Centre, 2410 Lee Avenue, Victoria, BC V8R 6V5, Canada; e-mail: iolivott{at}bccancer.bc.ca

PURPOSE: Adjuvant! (www.adjuvantonline.com) is a web-based tool that predicts 10-year breast cancer outcomes with and without adjuvant systemic therapy, but it has not been independently validated.

METHODS: Using the British Columbia Breast Cancer Outcomes Unit (BCOU) database, demographic, pathologic, staging, and treatment data on 4,083 women diagnosed between 1989 and 1993 in British Columbia with T1-2, N0-1, M0 breast cancer were abstracted and entered into Adjuvant! to calculate predicted 10-year overall survival (OS), breast cancer–specific survival (BCSS), and event-free survival (EFS) for each patient. Individual BCOU observed outcomes at 10 years were independently determined. Predicted and observed outcomes were compared.

RESULTS: Across all 4,083 patients, 10-year predicted and observed outcomes were within 1% for OS, BCSS, and EFS (all P > .05). Predicted and observed outcomes were within 2% for most demographic, pathologic, and treatment-defined subgroups. Adjuvant! overestimated OS, BCSS, and EFS in women younger than age 35 years (predicted – observed = 8.6%, 9.6%, and 13.6%, respectively; all P < .001) or with lymphatic or vascular invasion (LVI; predicted – observed = 3.6%, 3.8%, and 4.2%, respectively; all P < .05); these two prognostic factors were not automatically incorporated within the Adjuvant! algorithm. After adjusting for the distribution of LVI, using the prognostic factor impact calculator in Adjuvant!, 10-year predicted and observed outcomes were no longer significantly different.

CONCLUSION: Adjuvant! performed reliably. Patients younger than age 35 or with known additional adverse prognostic factors such as LVI require adjustment of risks to derive reliable predictions of prognosis without adjuvant systemic therapy and the absolute benefits of adjuvant systemic therapy.

Supported by grant No. 014452 from the Canadian Breast Cancer Research Alliance. Chris Bajdik, PhD, is supported by a scholar award from the Michael Smith Foundation for Health Research.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.


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