Abstract 1312
Background
Predictive online calculators are used by clinicians as decision aids in early breast cancer (EBC). While use statistics for these calculators have not been published, as of 2017 NHS Predict was being accessed more than 20,000 times a month. These predictive tools have not had accuracy & benefit of use prospectively confirmed in EBC, yet use of calculators has been encouraged in EBC guidelines. It is important to understand the populations informing model development & validation, to understand how data bias may impact predictions in under-represented subpopulations. This work sought to elucidate the risk of bias in model development & validation for 3 online EBC calculators (NHS Predict, Adjuvant! & Cancermath), in an effort to highlight sub-populations where calculated risk & therefore treatment benefit estimates may be less reliable.
Methods
A literature search was conducted in PubMed, search terms were “predict*” “adjuvant” “breast” & “algorithm”. Results were screened for relevance to the three predictive tools under scrutiny & additional references were extracted from relevant papers. Using a modified CHARMS checklist, the relevant sections of the development & validation papers were extracted.
Results
6 development & 24 validation papers were reviewed as summarised in the TableTable:
264P
Predict | Adjuvant | Cancermath | |
---|---|---|---|
Development population size & date range | 5694 1977-2008 | 37,968 1977-2007 | 499,724 1977-2007 |
Aged <35 in development population | 2% (111) | 0 | >0.5% |
Aged >65 in development population | 32% (1781) | 0 | >17% |
Tumour size >5cm in development population | 5% (287) | 0 | 0 |
Number of validation studies | 10 | 13 | 3 |
% retrospective | 100 | 100 | 100 |
Total number of patients in validation studies | 19,864 | 19,618 | 11,203 |
Age >65 in validations | 35% (7134) | 42% (8313) | 40% (4519) |
Age <35 in validations | 16% (3235) | 8% (1518) | 9% (1007) |
Tumour size >5cm in validations | 5% (287) | 5% (1015) | 6% (634) |
Universal exclusions | Multi-focal, inflammatory, male | Multi-focal, inflammatory, male | Multi-focal, inflammatory, male |
Neoadjuvant chemotherapy not an exclusion | 1 study (121 patients) | 0 | 0 |
Overall conclusions of validation authors | Earlier versions under-predicted mortality in women <35 Poor performance in tumours >5cm. | Poor performance in general in: <35 and >65 More advanced disease Malay ethnicity Overly optimistic survival predictions across subgroups in UK population. | Poor performance in < 35 Systematically under-predicted mortality, especially for ER-negative tumours. |
Conclusions
All 3 predictive tools have under-represented groups in their development cohorts, specifically those under 35 & over 65 years old, as well as larger tumours. Validation studies consistently demonstrate worse performance in these groups. However, due to inconsistent methodology in validation studies, quantitating the summary performance within & across tools is difficult. These predictive tools should be used with caution in under-represented populations. More work is required to look at clinical utility of tools as well as their statistical performance.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
714 - The feasibility and efficacy of gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian insufficiency in patient with malignant ovarian germ cell tumors
Presenter: Min Kyu Kim
Session: Poster Display session 2
Resources:
Abstract
1753 - Ex vivo cytotoxicity and in vivo antitumor activity of a novel highly selective STAT3 inhibitor YHO-1701 for ovarian and endometrial cancer
Presenter: Kosei Hasegawa
Session: Poster Display session 2
Resources:
Abstract
3739 - Mutational landscapes and tumor mutational burden expression in endometrial cancer
Presenter: Yingli Zhang
Session: Poster Display session 2
Resources:
Abstract
2109 - Clinical features and frequency of mismatch repair protein deficiency in ovarian clear cell and endometrioid carcinoma patients.
Presenter: Kazuhiro Takehara
Session: Poster Display session 2
Resources:
Abstract
4554 - Prospective study evaluating white adipose tissue inflammation and clinicopathologic features in endometrial cancer
Presenter: Lea Moukarzel
Session: Poster Display session 2
Resources:
Abstract
3645 - Cancer-specific survival with or without adjuvant chemotherapy in high-risk stage I endometrial cancer
Presenter: Jenny Ko
Session: Poster Display session 2
Resources:
Abstract
3394 - Pembrolizumab in Patients with MSI-H Advanced Endometrial Cancer from the KEYNOTE-158 Study
Presenter: David Omalley
Session: Poster Display session 2
Resources:
Abstract
3388 - Who drops out of cervical cancer screening? Results from the EDIFICE 6 survey
Presenter: Thibault de La Motte Rouge
Session: Poster Display session 2
Resources:
Abstract
2485 - Identification of a RNA-Seq Based Signature to Improve Prognostic for Uterine Sarcoma
Presenter: Jian-Guo Zhou
Session: Poster Display session 2
Resources:
Abstract
1049 - The Effect Of Multiple Interventions For Women At Risk For Cervical Cancer On Their Health Responsibility, Beliefs Regarding Cervical Cancer, And Having Screening: A Randomized Controlled Experiment
Presenter: Busra Altinel
Session: Poster Display session 2
Resources:
Abstract