An independent population-based validation of the adjuvant decision-aid for stage I-II breast cancer
Bibliographic record
Abstract
522 Background: ADJUVANT! (ADJ! [JCO 2001;19:980–91]) is a computer model which predicts 10-yr overall (OS), breast cancer-specific (BCSS) and event-free (EFS) survival with and without systemic therapy using recognised prognostic factors. Oncologists use it to provide information to patients about prognosis and treatment choice. ADJ! has not been independently validated despite widespread use. Methods: Demographic, pathology, staging and treatment data on 4,083 women with pT1–2, pN0–1 breast cancer referred to the BC Cancer Agency during 1989–1993 were entered into ADJ! 10-yr predicted (pred) OS, BCSS and EFS were calculated for each patient. Breast Cancer Outcomes Unit observed (obs) status at 10 years (disease event yes/no; alive; dead of disease; dead of other cause) was independently determined for each patient. ADJ! pred and BCOU obs rates were compared. Study subject pathologic characteristics were: 66% pT1, 34% pN1, 58% ER+, 37% grade 3 and 36% with lymphovascular invasion (LVI+). Three percent were age 20–35 years, 9.7% were age >75 years. Systemic therapy was: none=45%, tamoxifen (TAM) alone=30%, chemo (CT) alone=16% and CT+TAM=9%. Results: Across all 4083 patients, 10-yr pred and obs outcomes were within +/− 1% for OS (pred=71.7%, obs=72%), BCSS (pred=83.2%, obs=82.5%) and EFS (pred=71%, obs=70.1%). ADJ! overestimated EFS in women ≤ 35 yrs (pred=67.9%, obs=54.3%; p<0.002) and with LVI+ disease (pred=66.5%, obs=62.3%, p<0.001). ADJ! predicted BCSS and EFS rates within +/− 2% for patients not receiving systemic therapy or receiving TAM alone. ADJ! overestimated EFS with CT (pred=65%, obs=61.3%; p=0.056) and especially with combined CT+TAM (pred=68.1%, obs=61.7%; p=0.012). Conclusions: Overall, ADJ! performed reliably. Two factors to be added to future revisions of ADJ! were identified: age ≤ 35 and LVI+. ADJ! was overly optimistic about the outcomes of combined CT+TAM (by about 5% absolute) for OS, BCSS and EFS. Validation in large population-based databases like the BCOU, supports the translation of prediction models into practice. Supported in part by the Canadian Breast Cancer Research Alliance. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Adjuvant, Inc. Adjuvant, Inc. Adjuvant, Inc.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".