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SUMMARY:PREDICT: A NEW UK PROGNOSTIC MODE THAT PREDICTS SURVIVAL FOLLOWING
  SURGERY FOR INVASIVE BREAST CANCER (GC Wishart\, EM Azzato\, PDP Pharoah\
 , DC Greenberg\, J Rashbass\, O Kearins\, G Lawrence\, C Caldas C\, PM Rav
 din) - Prof. Gordon Wishart\, Addenbrooke's Hospital
DTSTART:20100112T120000Z
DTEND:20100112T130000Z
UID:TALK20996@talks.cam.ac.uk
CONTACT:Mala Jayasundera
DESCRIPTION:AIM: To develop and validate a prognostication model to predic
 t overall survival for women treated for early breast cancer in the UK bas
 ed on cancer registry data. Unlike SEER\, this dataset includes accurate i
 nformation on mode of detection as well as systemic therapy.\n\nMETHOD: Us
 ing the Eastern Cancer Registration & Information Centre (ECRIC) dataset\,
  information was collated for 5818 women diagnosed with invasive breast ca
 ncer in East Anglia from 1999-2003. All patients underwent surgery\, had r
 ecords of pathological staging (tumour size\, grade\, lymph node status\, 
 ER status)\, systemic treatment (chemotherapy\, hormone therapy\, both)\, 
 mode of detection (screen-detected\, symptomatic) and follow up\, censored
  on 31 December 2007. A model was derived from these data using Cox propor
 tional hazards\, with ER positive and ER negative tumours modelled separat
 ely\, and this was subsequently validated in an external dataset of 5468 p
 atients from the West Midlands Cancer Intelligence Unit (WMCIU). Validatio
 n was performed by comparing (a) observed and expected mortality (overall 
 & breast cancer specific) at 5 & 8 years and (b) receiver operating charac
 teristic (ROC) curves in both ECRIC & WMCIU datasets.\n\nRESULTS\nECRIC da
 taset\nDifference in overall observed/expected mortality <1% at 5 years (1
 4.8% vs 14.9%) and 8 years (18.9% vs 18.9%). Area under ROC curve (AUC) wa
 s 0.81.\nDifference in breast cancer specific observed/expected mortality 
 <1% at 5 years (10.6% vs 11.0%) and 8 years (12.9% vs 13.5%). AUC was 0.84
 .\nWMCIU dataset: \nDifference in overall observed/expected mortality < 1%
  at 5 years (15.8% vs 16.5%) and 8 years (17.5% vs 17.8%). AUC was 0.79.\n
 Difference in breast cancer specific observed/expected mortality <2% at 5 
 years (11.0% vs 12.6%) and 8 years (12.2% vs 13.6%). AUC was 0.82.\nOveral
 l model fit was good across all subgroups although the ER positive model p
 rovided better discrimination (AUC 0.82) than ER negative (AUC 0.75). Ther
 e was no significant difference between the ROC curves generated with ECRI
 C and WMCIU data (ER positive X2 = 0.17\, p=0.68\; ER negative X2 =0.00\, 
 P=0.95). \n\nCONCLUSION\nWe have developed a prognostication model for ear
 ly breast cancer based on data from a UK cancer registry that has included
  mode of detection for the first time. The model is well calibrated\, prov
 ides a high degree of discrimination and has been validated in a second pa
 tient cohort.  This model will underpin a new web-based prognostication an
 d treatment benefit tool for early breast cancer based on UK data (PREDICT
 ).\n
LOCATION:CRI Lecture Theatre
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