Inclusion of KI67 significantly improves performance of the PREDICT prognostication and prediction model for early breast cancer

Wishart, Gordon C.; Rakha, Emad; Green, Andrew; Ellis, Ian; Ali, Hamid Raza; Provenzano, Elena; Blows, Fiona M.; Caldas, Carlos; Pharoah, Paul D.P.

doi:10.1186/1471-2407-14-908

Authors

Gordon C. Wishart

EMAD RAKHA Emad.Rakha@nottingham.ac.uk
Professor of Breast Cancer Pathology

ANDREW GREEN andrew.green@nottingham.ac.uk
Associate Professor

Professor IAN ELLIS IAN.ELLIS@NOTTINGHAM.AC.UK
Professor of Cancer Pathology

Hamid Raza Ali

Elena Provenzano

Fiona M. Blows

Carlos Caldas

Paul D.P. Pharoah

Abstract

Background

PREDICT (http://www.predict.nhs.uk) is a prognostication and treatment benefit tool for early breast cancer (EBC). The aim of this study was to incorporate the prognostic effect of KI67 status in a new version (v3), and compare performance with the Predict model that includes HER2 status (v2).

Methods

The validation study was based on 1,726 patients with EBC treated in Nottingham between 1989 and 1998. KI67 positivity for PREDICT is defined as >10% of tumour cells staining positive. ROC curves were constructed for Predict models with (v3) and without (v2) KI67 input. Comparison was made using the method of DeLong.

Results

In 1274 ER+ patients the predicted number of events at 10 years increased from 196 for v2 to 204 for v3 compared to 221 observed. The area under the ROC curve (AUC) improved from 0.7611 to 0.7676 (p?=?0.005) in ER+ patients and from 0.7546 to 0.7595 (p?=?0.0008) in all 1726 patients (ER+ and ER-).

Conclusion

Addition of KI67 to PREDICT has led to a statistically significant improvement in the model performance for ER+ patients and will aid clinical decision making in these patients. Further studies should determine whether other markers including gene expression profiling provide additional prognostic information to that provided by PREDICT.

Citation

Wishart, G. C., Rakha, E., Green, A., Ellis, I., Ali, H. R., Provenzano, E., …Pharoah, P. D. (2014). Inclusion of KI67 significantly improves performance of the PREDICT prognostication and prediction model for early breast cancer. BMC Cancer, 14(1), Article 908. https://doi.org/10.1186/1471-2407-14-908

Journal Article Type	Article
Acceptance Date	Nov 20, 2014
Online Publication Date	Dec 3, 2014
Publication Date	2014-12
Deposit Date	Oct 16, 2018
Publicly Available Date	Oct 17, 2018
Journal	BMC Cancer
Publisher	BMC
Peer Reviewed	Peer Reviewed
Volume	14
Issue	1
Article Number	908
DOI	https://doi.org/10.1186/1471-2407-14-908
Public URL	https://nottingham-repository.worktribe.com/output/1169792
Publisher URL	https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-14-908