Accuracy validation of adjuvant! online in Taiwanese breast cancer patients--a 10-year analysis.

BACKGROUND: Adjuvant! Online ( http://www.adjuvantonline.com) is an Internet-based software program that allows clinicians to make predictions about the benefits of adjuvant therapy and 10-year survival probability for early-stage breast cancer patients. This model has been validated in Western countries such as the United States, United Kingdom, Canada, Germany, and Holland. The aim of our study was to investigate the performance and accuracy of Adjuvant! Online in a cohort of Taiwanese breast cancer patients. METHODS: Data on the prognostic factors and clinical outcomes of 559 breast cancer patients diagnosed at the National Cheng Kung University Hospital in Tainan between 1992 and 2001 were enrolled in the study. Comprehensive demographic, clinical outcome data, and adjuvant treatment data were entered into the Adjuvant! Online program. The outcome prediction at 10 years was compared with the observed and predicted outcomes using Adjuvant! Online. RESULTS: Comparison between low- and high-risk breast cancer patient subgroups showed significant differences in tumor grading, tumor size, and lymph node status (p < 0.0001). The mean 10-year predicted death probability in 559 patients was 19.44%, and the observed death probability was 15.56%. Comparison with the Adjuvant! Online-predicted breast cancer-specific survival (BCSS) showed significant differences in the whole cohort (p < 0.001). In the low-risk subgroup, the predicted and observed outcomes did not differ significantly (3.69% and 3.85%, respectively). In high-risk patients, Adjuvant! Online overestimated breast cancer-specific survival (p = 0.016); the predicted and observed outcomes were 21.99% and 17.46%, respectively. CONCLUSIONS: Adjuvant! Online accurately predicted 10-year outcomes and assisted in decision making about adjuvant treatment in low-risk breast cancer patients in our study, although the results were less accurate in the high-risk subgroup. Development of a prognostic program based on a national database should be considered, especially for high-risk breast cancer patients in Taiwan.

Clinicopathological features of triple-negative breast cancer in Taiwanese women.

BACKGROUND: The goal of this study was to identify prognostic factors that influence the survival outcome of Taiwanese women with triple-negative breast cancer (TNBC). METHODS: Of 709 patients with breast cancer diagnosed between January 2002 and December 2005, 152 patients (21.4 %) were diagnosed with TNBC. The overall survival and disease-free survival were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Univariate and multivariate analyses were used to identify the prognostic factors, and the prognostic significance of these factors in TNBC patients was reviewed. RESULTS: The median follow-up time was 70.5 months. Kaplan-Meier analysis showed significant difference between the tumor subgroups (TNBC vs. non-TNBC) in 5-year overall survival (p = 0.01) and 5-year disease-free survival (p < 0.0001). Univariate analysis showed that tumor subgroup (TNBC vs. non-TNBC) was a significant predictor of 5-year overall survival and disease-free survival. Tumor size, lymph node status, stage, grade, estrogen receptor status, progesterone receptor status, and HER2 status were also significant. In the multivariate analysis, only tumor size, lymph node status, and grade were significantly related to 5-year overall survival and disease-free survival. In TNBC patients, nodal status was significantly related to 5-year overall survival (HR = 7.47, p < 0.0001) and 5-year disease-free survival (HR = 3.913, p = 0.001). CONCLUSION: In TNBC, nodal status is a prognostic indicator of survival. The TNBC subgroup had a worse pattern of relapse compared to the non-TNBC, irrespective of nodal negative or nodal positive breast cancer patients. We suggest that this subgroup should receive aggressive treatment to prevent early recurrence or death. Further prospective clinical trials are warranted to identify a more efficient treatment regimen to improve the prognosis.