IJzerman, Maarten J.

Klaase, Joost M.

Siesling, Sabine

Sonke, Gabe S.

Vliegen, Ingrid M.H.

Witteveen, Annemieke

Vliegen, Ingrid

IJzerman, Maarten Joost

University of Twente Research Information

The objective was to extent the recently developed andvalidated time-dependent logistic regression model and web-based INFLUENCE nomogram. This nomogram is suitablefor the annual long term risk prediction of locoregionalrecurrence (LRR) in individual breast cancer patients and cansupport clinical decisions with regard to the follow-upPrint screen of the nomogram, from : www.utwente.nl/influenceNetherlands Cancer Registry (NCR):Patients - Women first diagnosed with early breast cancerbetween 2003-2006 in all Dutch hospitals were selected fromthe NCR with five year of recurrence follow-up (n=37,230).For patients diagnosed in 2003 follow-up was complete forten years. In the first five years following primary breastcancer treatment 3.7% of the selected patients developed aLRR as a first event, in ten years 6.2%. Risks - Risk factorswere determined using logistic regression and the five yearrisks were calculated per year, conditional on not beingdiagnosed in the previous year. Cox regression was used forthe ten year follow-up. Validation – Internal validation wasperformed by bootstrapping. Data on primary tumorsdiagnosed between 2007-2008 in 43 Dutch hospitals wasused for external validation of the nomogram (n=12,308).Thresholds - Based on the current follow-up, the lower riskboundary and quantiles for intervals were determined. Withthese thresholds redistribution of visits was established for alow, middle and high risk group, over ten years of follow-up.The final model included the variables grade, size,multifocality, and nodal involvement of the primary tumor, andwhether patients were treated with radio-, chemo- or hormonetherapy. Model predictions were well calibrated..Given the thresholds, the medium (<50, hormone therapy)risk group should receive two follow-up visits, and the highgroup (>50, no hormone therapy) seven during the follow-upperiod of ten years. The low risk group (>50, hormonetherapy) remained below the threshold for all the ten years.This validated and time-dependent nomogram for theprediction of annual LRR risks over ten years is simple to useand shows a good predictive ability in the Dutch population. Itcan be used as an instrument to identify patients with a low orhigh risk of LRR who might benefit from a less or moreintensive and longer follow-up after breast cancer and to aidclinical decision-making for personalized follow-up.TIME-DEPENDENT NOMOGRAM FOR RISK OF LOCOREGIONAL RECURRENCE Annemieke Witteveen1, Ingrid M.H.Vliegen2, Gabe S. Sonke3, Joost M. Klaase4, Maarten J. IJzerman1, Sabine Siesling1,51 Dept. of Health Technology and Services Research (HTSR), MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands, 2 Dept. of Industrial Engineering and Business Information Systems (IEBIS), Center for Healthcare Operations Improvement & Research, University of Twente, Enschede, the Netherlands, 3 Dept. of Medical Oncology, Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands, 4 Dept. of Surgery, Medical Spectrum Twente (MST), Enschede, the Netherlands, 5 Dept. of Registration and Research, Netherlands Comprehensive Cancer Centre Organisation (IKNL), Utrecht, the NetherlandsMore information:Annemieke Witteveen, MScPhD candidatewww.utwente.nl/influenceA.Witteveen@utwente.nl0246810Risk (%)2 4 6 8 10Predicted risk (%)observed predicted0.000.250.500.751.00Sensitivity0.00 0.25 0.50 0.75 1.001-SpecificityModelling group ROC area: 0.711Validation group ROC area: 0.707BACKGROUND PATIENTS AND METHODS RESULTSCONCLUSIONSIN EARLY BREAST CANCER PATIENTS: 10 YEAR EXTENSIONP6-09-03?<5y<10y3.7%6.2%Estimates in the validationcohort did not differ significantlyfrom the index cohort.In 0.7% of the patients, the risk of LRR between year 5-10was higher than the average risk of all patients in the firstfive years. All of these patients were aged below 50, had atumor size larger than 2 cm, non-negative hormone status,received radiotherapy, but no hormone therapy and 19%developed a recurrence during ten years.The cumulative hazard of the population after five year was0.0448, ( hazard interval of 0.00896 per visit), the hazardafter five years was 0.0068 ( lower boundary for follow-up).

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Time-dependent nomogram for risk of locoregional recurrence in early breast cancer patients:10 year extension

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Time-dependent nomogram for risk of locoregional recurrence in early breast cancer patients: 10 year extension

https://ris.utwente.nl/ws/files/17973966/Witteveen,Siesling%20SABCS%20-%20Time-dependent%20nomogram%20for%20risk%20of%20locoregional%20recurrence%20in%20early%20breast%20cancer%20patients,%2010%20year%20extension.pdf

Time-dependent nomogram for risk of locoregional recurrence in early breast cancer patients: 10 year extension

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