164P - The prognostic performance of Adjuvant! Online and Nottingham Prognostic Index in young breast cancer patients: an international multicentre hospit...

Date 10 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Breast Cancer
Presenter Matteo Lambertini
Citation Annals of Oncology (2016) 27 (6): 43-67. 10.1093/annonc/mdw364
Authors M. Lambertini1, A.C. Pinto2, L. Ameye3, L. Jongen4, L. Del Mastro5, F. Puglisi6, F. Poggio1, M. Bonotto7, G. Floris8, K. van Asten4, H. Wildiers4, P. Neven4, E. de Azambuja9, M. Paesmans3, H.A. Azim Jr.10
  • 1Department Of Medical Oncology, U.o. Oncologia Medica 2, IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro, 16132 - Genova/IT
  • 2Department Of Medicine, Institute Jules Bordet, 1000 - Brussels/BE
  • 3Data Centre, Institute Jules Bordet, 1000 - Brussels/BE
  • 4Department Of Oncology, University Hospitals Leuven - Campus Gasthuisberg, Leuven/BE
  • 5Medical Oncology, IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro, Genova/IT
  • 6Department Of Medical And Biological Sciences, University of Udine, Udine/IT
  • 7Department Of Medical Oncology, AOU Santa Maria della Misericordia, 33100 - Udine/IT
  • 8Department Of Imaging And Pathology, University Hospitals Leuven - Campus Gasthuisberg, Leuven/BE
  • 9Medical Oncology, Institute Jules Bordet, 1000 - Brussels/BE
  • 10Medical Oncology, Institut Jules Bordet, 1000 - Brussels/BE



Adjuvant! Online (AOL) and Nottingham Prognostic Index (NPI) are prognostic tools that are widely used to aid treatment decision-making. Although performing globally well, their performance is unclear in populations other than those used in their validation studies and particularly in specific subgroups such as women ≤ 40 years. The present study aimed to evaluate for the first time the prognostic performance of AOL and NPI in young early breast cancer patients.


This is a multicentre hospital-based retrospective cohort study including young (≤ 40 years) and older (55-60 years) breast cancer patients treated from January 2000 until December 2004 at 4 large Belgian and Italian institutions. Predicted 10-year overall survival (OS) and disease-free survival (DFS) using AOL and 10-year OS using NPI were calculated for every patient. To assess calibration, the trimmed mean of the predicted 10-year outcomes was compared to the observed (Kaplan-Meier estimate at 10 years) 10-year rates by using one-sample t-test. Discriminatory accuracy was assessed by calculating the area under the receiver-operator characteristic curve and the corresponding 95% confidence intervals for 10-year predicted OS and DFS. Vital status was cross-checked with the national registries in Belgium and Italy.


A total of 1,283 patients were included (376 in the young and 907 in the older cohorts, respectively). AOL accurately predicted 10-year OS (absolute difference: 0.66%; p = 0.37) in the young cohort, but overestimated 10-year DFS by 7.66% (p = 0.003). In the older cohort, AOL significantly underestimated both 10-year OS and DFS, by 7.20% (p 


In young breast cancer patients, AOL is a reliable tool in predicting OS at 10 years but not DFS, while the calibration performance of NPI is suboptimal. In patients aged 55-60 years, the role of AOL and NPI deserves further investigations.

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All authors have declared no conflicts of interest.