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class="bkr_bib"><h1 id="_NBK576822_"><span itemprop="name">Evidence reviews for adjuvant systemic therapy planning</span></h1><div class="subtitle">Early and locally advanced breast cancer: diagnosis and management</div><p><b>Evidence review C</b></p><p><i>NICE Guideline, No. 101</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2018 Jul</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3008-1</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div></div><div class="bkr_clear"></div></div><div id="chc.s1"><h2 id="_chc_s1_">Adjuvant systemic therapy planning</h2><p>This evidence report contains information on 2 reviews relating to adjuvant systemic therapy planning.</p><ul id="l212"><li id="lt441" class="half_rhythm"><div><a href="#chc.s1.1">Review question 3.1</a>. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</div></li><li id="lt442" class="half_rhythm"><div><a href="#chc.s1.2">Review question 3.2</a> What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</div></li></ul><div id="chc.s1.1"><h3>Review question 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h3><div id="chc.s1.1.1"><h4>Introduction</h4><p>Current UK recommendations in the previous guideline CG80 (<a class="bibr" href="#chc.s1.1.ref6" rid="chc.s1.1.ref6">NICE 2009</a>), and from the Royal College of Pathologists (<a class="bibr" href="#chc.s1.1.ref7" rid="chc.s1.1.ref7">RCPath, 2016</a>), state that oestrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) biomarkers should be assessed in all invasive breast cancers. This biomarker analysis can provide important prognostic and predictive information to help direct further adjuvant management breast cancer after surgery.</p><p>ER positivity in breast cancers can predict a potential response to endocrine-based treatments and these cancers are known to have an overall better prognosis than ER-negative cancers. Progesterone receptor (PR) is from the same family of molecules as ER, but CG80 recommended not to routinely test all breast cancers for PR as, at the time, there was no strong evidence to support PR being predictive of a response to endocrine therapy (despite being independently prognostic for relapse-free survival and overall survival).</p><p>The co-expression of ER and PR does vary between breast cancers. Whilst the majority of breast cancers which are ER positive are also PR positive, many are PR negative, and studies have now shown these to have a worse prognosis and to be less responsive to endocrine therapies. Some people have breast cancers that are negative for each of ER, PR and HER2. As none of the 3 biomarkers are expressed in these cancers, they are conventionally referred to as ‘triple negative’ and are associated with a poor prognosis without treatment, but the cancer may respond well to certain forms of chemotherapy.</p><p>The purpose of this review question is to determine if establishing PR status affects planning for adjuvant chemotherapy.</p></div><div id="chc.s1.1.2"><h4>PICO table</h4><p>See <a class="figpopup" href="/books/NBK576822/table/chc.tab1/?report=objectonly" target="object" rid-figpopup="figchctab1" rid-ob="figobchctab1">Table 1</a> for a summary of the population, intervention, comparison and outcome (PICO) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab1"><a href="/books/NBK576822/table/chc.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figchctab1" rid-ob="figobchctab1"><img class="small-thumb" src="/books/NBK576822/table/chc.tab1/?report=thumb" src-large="/books/NBK576822/table/chc.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICO table)." /></a><div class="icnblk_cntnt"><h4 id="chc.tab1"><a href="/books/NBK576822/table/chc.tab1/?report=objectonly" target="object" rid-ob="figobchctab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICO table). </p></div></div><p>For full details see review protocol in <a href="#chc.appa">appendix A</a>.</p></div><div id="chc.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>; see the <a href="/books/n/niceng101erm/?report=reader" class="toc-item">methods</a> chapter for further information. Methods specific to this review question are described in the review protocol in <a href="#chc.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy.</p></div><div id="chc.s1.1.4"><h4>Clinical evidence</h4><div id="chc.s1.1.4.1"><h5>Included studies</h5><p>There were no test and treat randomised controlled trials (RCTs) identified by the literature search. In test and treat studies, only participants who get discrepant test results (for example, chemotherapy indicated versus chemotherapy not indicated) would receive different treatment and only a proportion of those may benefit from differences in treatment. Therefore, the committee deemed it inappropriate to drop down the evidence hierarchy to include non-randomised studies as it is likely that bias inherent in such studies would dominate any treatment effect.</p><p>The study selection flow chart is in <a href="#chc.appc">appendix C</a>.</p></div><div id="chc.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review with reasons for their exclusions are provided in <a href="#chc.appk">appendix K</a>.</p></div></div><div id="chc.s1.1.5"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>No studies were included in this review question.</p></div><div id="chc.s1.1.6"><h4>Economic evidence</h4><p>A systematic review of the economic literature was conducted but no relevant studies were identified which were applicable to this review question. Economic modelling was not undertaken for this question because other topics were agreed as higher priorities for economic evaluation.</p></div><div id="chc.s1.1.7"><h4>Formal consensus</h4><p>The committee decided that a modified form of the nominal group technique would be the most appropriate method for producing recommendations regarding the appropriateness of PR testing. The method used for the nominal group technique is described in full within the methods chapter.</p><p>Key issues related to progesterone receptor testing were identified from relevant papers identified by the current search results (<a class="bibr" href="#chc.s1.1.ref1" rid="chc.s1.1.ref1">Duffy 2005</a>; <a class="bibr" href="#chc.s1.1.ref3" rid="chc.s1.1.ref3">Hammond 2010</a>, <a class="bibr" href="#chc.s1.1.ref4" rid="chc.s1.1.ref4">Harris 2007</a>; <a class="bibr" href="#chc.s1.1.ref5" rid="chc.s1.1.ref5">Henry 2016</a>) the previous guideline CG80 (<a class="bibr" href="#chc.s1.1.ref6" rid="chc.s1.1.ref6">NICE 2009</a>), key papers and guidelines identified by the guideline committee (<a class="bibr" href="#chc.s1.1.ref2" rid="chc.s1.1.ref2">Early Breast Cancer Trialists’ Collaborative Group [EBCTCG] 2011</a>), and from protocol discussions with the committee. These were used to generate statements covering the following areas: prognosis based on progesterone receptor status, impact of progesterone receptor status on endocrine therapy and chemotherapy, and assessment of progesterone receptor status. These statements were placed into a questionnaire and distributed to the guideline committee to be rated.</p><p>The first round of rating was completed by 11 of 16 committee members. Percentage agreement values were calculated and comments collated for each statement; the rankings and comments were then presented to the committee members to facilitate a structured discussion. Two statements were redrafted based on the comments from the committee members and re-distributed for rating as a second questionnaire; this round was completed by 10 of 16 committee members. A blank copy of the questionnaire (including re-rated statements) can be found in <a href="#chc.appm">appendix M</a> and consensus ratings can be found in <a href="#chc.appn">appendix N</a>.</p><p>A brief summary of level of consensus is depicted in <a class="figpopup" href="/books/NBK576822/table/chc.tab2/?report=objectonly" target="object" rid-figpopup="figchctab2" rid-ob="figobchctab2">Table 2</a> below.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab2"><a href="/books/NBK576822/table/chc.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figchctab2" rid-ob="figobchctab2"><img class="small-thumb" src="/books/NBK576822/table/chc.tab2/?report=thumb" src-large="/books/NBK576822/table/chc.tab2/?report=previmg" alt="Table 2. Summary of nominal group technique process followed for the development of recommendations on progesterone receptor testing." /></a><div class="icnblk_cntnt"><h4 id="chc.tab2"><a href="/books/NBK576822/table/chc.tab2/?report=objectonly" target="object" rid-ob="figobchctab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of nominal group technique process followed for the development of recommendations on progesterone receptor testing. </p></div></div></div><div id="chc.s1.1.8"><h4>Evidence statements</h4><p>The committee agreed that:
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<ul id="l217"><li id="lt448" class="half_rhythm"><div>positive progesterone receptor status is associated with favourable prognosis and negative progesterone receptor status is associated with worse prognosis</div></li><li id="lt449" class="half_rhythm"><div>progesterone receptor status provides additional information to oestrogen receptor status that may be beneficial when considering the benefit of adjuvant hormone treatment</div></li><li id="lt450" class="half_rhythm"><div>negative progesterone receptor status is one factor that may increase benefit from chemotherapy, and likelihood that it is offered in borderline cases</div></li><li id="lt451" class="half_rhythm"><div>progesterone receptor status is relevant when making decisions regarding adjuvant therapy and should be assessed in all newly diagnosed invasive breast cancers.</div></li></ul></p></div><div id="chc.s1.1.9"><h4>The committee’s discussion of the evidence</h4><div id="chc.s1.1.9.1"><h5>Interpreting the evidence</h5><div id="chc.s1.1.9.1.1"><h5>The outcomes that matter most</h5><p>The committee identified disease-free survival and overall survival as critical outcomes. Treatment-related morbidity was selected as an important outcome to examine the impact of any additional treatment required as a result of progesterone receptor testing. These outcomes are valued by service users as increased survival is prioritised; however, treatment-related morbidities can have a significant impact on health-related quality of life and adherence to treatment.</p><p>No test and treat studies were identified from the literature search, therefore there was no evidence for any of the outcomes reported in the PICO.</p><p>The impact of PR status on prognosis, benefit from endocrine therapy and benefit from chemotherapy were identified through discussions with the committee as key areas related to the need for PR testing. These areas were used as guides for generating statements to be ranked by the committee using a modified form of the nominal group technique.</p></div><div id="chc.s1.1.9.1.2"><h5>The quality of the evidence</h5><p>No published evidence was identified for this review. Although there were high levels of agreement in the nominal group technique for statements which informed and supported recommendations, this formal consensus method constitutes low quality evidence.</p></div><div id="chc.s1.1.9.1.3"><h5>Benefits and harms</h5><p>The addition of PR testing to ER testing will provide further information on which to base decisions regarding adjuvant hormone therapy and chemotherapy resulting in better tailored treatment. Specifically, tumours that are negative for PR have a worse prognosis and therefore may receive greater benefit from chemotherapy. Determining negative PR status may therefore increase the likelihood of chemotherapy being offered in borderline cases.</p><p>Assessing PR status upfront in all newly diagnosed invasive cancers reduces delays in decision making that may occur if determining progesterone receptor status is carried out at a later stage, and not at the same time as ER testing. This may allow earlier commencement of treatment. Earlier treatment may lead to a reduction in recurrence and mortality. The committee made an additional recommendation therefore that the 3 tests (ER, PR and HER2) should all be requested simultaneously at the time of initial histopathological diagnosis, to prevent delays in treatment.</p><p>No harms were identified by the committee as no additional procedures are required for progesterone receptor testing. Treatment-related morbidities were discussed, but the committee thought that there would not be significant increases in morbidities as currently the majority of patients do receive progesterone receptor testing and corresponding treatment when indicated, but the testing is not routinely done upfront.</p><p>The benefits identified combined with the lack of harms led the committee to make a strong recommendation in this area despite the low quality of the evidence.</p></div></div><div id="chc.s1.1.9.2"><h5>Cost effectiveness and resource use</h5><p>A systematic review of the economic literature was conducted but no relevant studies were identified which were applicable to this review question.</p><p>There is the potential for cost increases associated with testing PR status. However the committee did not think the increase would be large as some centres are already performing upfront PR testing and it would be more expensive if a second test was required to determine PR status.</p><p>There is also a potential cost increase associated with additional adjuvant endocrine therapy and chemotherapy that may be indicated as a result of the PR test. This is unlikely to be large as the recommendation will have a greater impact on the timing of PR testing rather than whether the test, and indicated treatment, occurs.</p><p>In contrast, performing the PR test upfront will produce cost savings as pathology results will not need to be discussed at multiple multidisciplinary team meetings, and fewer second appointments will be required for decision making and adjuvant treatment planning; currently, an additional multidisciplinary team meeting may be required to discuss the impact of PR status if this information is not available at the initial meeting. There is also a potential for cost savings if treatment improvements reduce recurrence and/or mortality as there will be a decreased need for future procedures, treatments and hospice care.</p></div><div id="chc.s1.1.9.3"><h5>Other factors the committee took into account</h5><div id="chc.s1.1.9.3.1"><h5>Ethical considerations</h5><p>There are elevated rates of triple-negative breast cancer among some ethnic groups, for example Afro-Caribbean people, and they are therefore more likely to be affected by delays to optimal treatment if progesterone receptor status is not known. The current recommendation will reduce this inequality as progesterone receptor testing will be performed upfront allowing for earlier determination of triple-negative status.</p></div><div id="chc.s1.1.9.3.2"><h5>Methods for assessing and reporting progesterone-receptor status</h5><p>The committee recommended that PR status be assessed using immunohistochemical techniques. This is standard clinical practice and all UK laboratories using hormone receptor assays are subject to national quality assurance. Furthermore, the committee recommended that results are reported quantitatively (as opposed to dichotomously) as the degree of positivity is directly correlated with a better prognosis.</p></div></div></div><div id="rl.r4"><h4>References</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.1.ref1"><p id="p-56">
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<strong>Duffy 2005</strong>
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</p>Duffy, M. J. (2005). Predictive markers in breast and other cancers: a review. Clinical chemistry, 51, 494–503. [<a href="https://pubmed.ncbi.nlm.nih.gov/15637130" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15637130</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.1.ref2"><p id="p-57">
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<strong>EBCTCG 2011</strong>
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</p>Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). (2011). Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet, 378, 771–784. [<a href="/pmc/articles/PMC3163848/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3163848</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21802721" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21802721</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.1.ref3"><p id="p-58">
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<strong>Hammond 2010</strong>
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</p>Hammond, M. E. H., Hayes, D. F., Dowsett, M., Allred, D. C., Hagerty, K. L., Badve, S., Fitzgibbons, P. L., Francis, G., Goldstein, N. S., Hayes, M., Hicks, D. G., Lester, S., Love, R., Mangu, P. B., McShane, L., Miller, K., Osborne, C. K., Paik, S., Perlmutter, J., Rhodes, A., Sasano, H., Schwartz, J. N., Sweep, F. C. G., Taube, S., Torlakovic, E. E., Valenstein, P., Viale, G., Visscher, D., Wheeler, T., Williams, R. B., Wittliff, J. L., Wolff, A. C. (2010). American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Archives of Pathology & Laboratory Medicine, 134, e48–e72. [<a href="https://pubmed.ncbi.nlm.nih.gov/20586616" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20586616</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.1.ref4"><p id="p-59">
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<strong>Harris 2007</strong>
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</p>Harris, L., Fritsche, H., Mennel, R., Norton, L., Ravdin, P., Taube, S., Somerfield, M. R., Hayes, D. F., Bast
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Jr, R. C. (2007). American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. Journal of Clinical Oncology, 25, 5287–5312. [<a href="https://pubmed.ncbi.nlm.nih.gov/17954709" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17954709</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.1.ref5"><p id="p-60">
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<strong>Henry 2016</strong>
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</p>Henry, N. L., Somerfield, M. R., Abramson, V. G., Allison, K. H., Anders, C. K., Chingos, D. T., Hurria, A., Openshaw, T. H., Krop, I. E. (2016). Role of patient and disease factors in adjuvant systemic therapy decision making for early-stage, operable breast cancer: American Society of Clinical Oncology endorsement of Cancer Care Ontario guideline recommendations. Journal of Clinical Oncology, 34, 2303–2311. [<a href="https://pubmed.ncbi.nlm.nih.gov/27001586" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27001586</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.1.ref6"><p id="p-61">
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<strong>NICE 2009</strong>
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</p>National Institute for Health and Clinical Excellence. (2009). Early and locally advanced breast cancer: diagnosis and treatment. NICE guideline (CG80). [<a href="https://pubmed.ncbi.nlm.nih.gov/19167201" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19167201</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.1.ref7"><p id="p-62">
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<strong>RCPath 2016</strong>
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</p>Ellis, I. O., Carder, P., Hales, S., Lee, A. H. S., Pinder, S. E., Rakha, E., Stephenson, T., Al-Sam, S., Deb, R., Hanby, A., Liebmann, R., Provenzano, E., Rowlands, D., Wells, A., Anderson, N., Girling, A., Ibrahim, M., Mallon, E., Quinn, C. (2016). Pathology reporting of breast disease in surgical excision specimens incorporating the dataset for histological reporting of breast cancer. The Royal College of Pathologists: London, UK.</div></p></li></ul></div></div><div id="chc.s1.2"><h3>Review question 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h3><div id="chc.s1.2.1"><h4>Introduction</h4><p>Planning adjuvant treatment is complex and incorporates a variety of prognostic and predictive factors. In order to identify which people would benefit from adjuvant therapy, a number of prognostic tools have been developed. These take into account a number of factors such as age, comorbidities, tumour staging and biomarkers, and assess the risk of an individual person developing recurrent disease and/or dying within 10 years when receiving a specific treatment. These prognostic tools can be used jointly by the person and their doctor to determine the most appropriate adjuvant treatment (chemotherapy, endocrine therapy, or no therapy).</p><p>The aim of this review is to determine which of the currently available prognostic tools is most reliable at correctly predicting survival and the benefits of adjuvant treatment.</p><p>See <a class="figpopup" href="/books/NBK576822/table/chc.tab3/?report=objectonly" target="object" rid-figpopup="figchctab3" rid-ob="figobchctab3">Table 3</a> for a description of the prognostic tools included in this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab3"><a href="/books/NBK576822/table/chc.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figchctab3" rid-ob="figobchctab3"><img class="small-thumb" src="/books/NBK576822/table/chc.tab3/?report=thumb" src-large="/books/NBK576822/table/chc.tab3/?report=previmg" alt="Table 3. Description of the prognostic tools." /></a><div class="icnblk_cntnt"><h4 id="chc.tab3"><a href="/books/NBK576822/table/chc.tab3/?report=objectonly" target="object" rid-ob="figobchctab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Description of the prognostic tools. </p></div></div></div><div id="chc.s1.2.2"><h4>PICOTS table</h4><p>See <a class="figpopup" href="/books/NBK576822/table/chc.tab4/?report=objectonly" target="object" rid-figpopup="figchctab4" rid-ob="figobchctab4">Table 4</a> for a summary of the population, intervention (predictive prognostic tool), comparison, outcome, timing and setting (PICOTS) characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab4"><a href="/books/NBK576822/table/chc.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figchctab4" rid-ob="figobchctab4"><img class="small-thumb" src="/books/NBK576822/table/chc.tab4/?report=thumb" src-large="/books/NBK576822/table/chc.tab4/?report=previmg" alt="Table 4. Summary of the protocol (PICOTS table)." /></a><div class="icnblk_cntnt"><h4 id="chc.tab4"><a href="/books/NBK576822/table/chc.tab4/?report=objectonly" target="object" rid-ob="figobchctab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICOTS table). </p></div></div><p>For full details see the review protocol in <a href="#chc.appa">appendix A</a>.</p></div><div id="chc.s1.2.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>; see the <a href="/books/n/niceng101erm/?report=reader" class="toc-item">methods</a> chapter for further information. Methods specific to this review question are described in the review protocol in <a href="#chc.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy.</p></div><div id="chc.s1.2.4"><h4>Clinical evidence</h4><p>We included validation studies that reported sensitivity, specificity, calibration and discrimination of validated predictive prognostic tools.</p><p>It was agreed with the committee that sensitivity or specificity would be considered high when sensitivity or specificity was 90% or higher, and moderate when sensitivity or specificity was between 75% and 89%. However none of the studies reported these outcomes.</p><p>The mortality ratio is defined as the ratio of observed number of deaths in a study population and the expected number of deaths. In this review, a tool was judged to have good calibration if the ratio ranged from 0.8 to 1.2 (as suggested by <a class="bibr" href="#chc.s1.2.ref5" rid="chc.s1.2.ref5">Debray 2017</a>).</p><p>Discrimination is a measure to assess how well a tool identifies people with worse survival, and it is often reported by the concordance c-statistic (also known as AUC). In this review a tool was judged to have good discrimination if c-statistic was above 0.75 (as suggested by <a class="bibr" href="#chc.s1.2.ref5" rid="chc.s1.2.ref5">Debray 2017</a>).</p><div id="chc.s1.2.4.1"><h5>Included studies</h5><p>Seven studies (number of participants, N=27,287) were included in this review (<a class="bibr" href="#chc.s1.2.ref1" rid="chc.s1.2.ref1">Blamey 2007</a>, <a class="bibr" href="#chc.s1.2.ref2" rid="chc.s1.2.ref2">Campbell 2009</a>, <a class="bibr" href="#chc.s1.2.ref3" rid="chc.s1.2.ref3">Campbell 2010</a>, <a class="bibr" href="#chc.s1.2.ref4" rid="chc.s1.2.ref4">Candido dos Reis 2017</a>, <a class="bibr" href="#chc.s1.2.ref6" rid="chc.s1.2.ref6">Maishman 2015</a>, <a class="bibr" href="#chc.s1.2.ref9" rid="chc.s1.2.ref9">Wishart 2010</a> and <a class="bibr" href="#chc.s1.2.ref10" rid="chc.s1.2.ref10">Wishart 2014</a>).</p><p>One study looked at the Nottingham Prognostic Index (NPI) (<a class="bibr" href="#chc.s1.2.ref1" rid="chc.s1.2.ref1">Blamey 2007</a>), 1 study looked at Adjuvant! Online (<a class="bibr" href="#chc.s1.2.ref2" rid="chc.s1.2.ref2">Campbell 2009</a>), 1 study looked at the Oxford Prognostic Index (OPI) (<a class="bibr" href="#chc.s1.2.ref3" rid="chc.s1.2.ref3">Campbell 2010</a>), and 4 studies looked at PREDICT (<a class="bibr" href="#chc.s1.2.ref4" rid="chc.s1.2.ref4">Candido dos Reis 2017</a>, <a class="bibr" href="#chc.s1.2.ref6" rid="chc.s1.2.ref6">Maishman 2015</a>, <a class="bibr" href="#chc.s1.2.ref9" rid="chc.s1.2.ref9">Wishart 2010</a> and <a class="bibr" href="#chc.s1.2.ref10" rid="chc.s1.2.ref10">Wishart 2014</a>). Because a number of versions of PREDICT exist, the authors were contacted to seek clarification.</p><p>All studies were conducted with a UK population.</p><p>The clinical evidence from these studies is summarised in <a class="figpopup" href="/books/NBK576822/table/chc.tab5/?report=objectonly" target="object" rid-figpopup="figchctab5" rid-ob="figobchctab5">Table 5</a>. Please note that GRADE profiles are not applicable to this review question. See also the study selection flow chart in <a href="#chc.appc">appendix C</a>, forest plots in <a href="#chc.appe">appendix E</a>, study evidence tables in <a href="#chc.appd">appendix D</a> and exclusion list in <a href="#chc.appk">appendix K</a>.</p><p>This review updates a question from the previous guideline CG80 (<a class="bibr" href="#chc.s1.2.ref7" rid="chc.s1.2.ref7">NICE 2009</a>). However no studies were identified in the previous guideline.</p></div><div id="chc.s1.2.4.2"><h5>Excluded studies</h5><p>Studies not included in this review with reasons for their exclusions are provided in <a href="#chc.appk">appendix K</a>.</p></div></div><div id="chc.s1.2.5"><h4>Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab5"><a href="/books/NBK576822/table/chc.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figchctab5" rid-ob="figobchctab5"><img class="small-thumb" src="/books/NBK576822/table/chc.tab5/?report=thumb" src-large="/books/NBK576822/table/chc.tab5/?report=previmg" alt="Table 5. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="chc.tab5"><a href="/books/NBK576822/table/chc.tab5/?report=objectonly" target="object" rid-ob="figobchctab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See <a href="#chc.appd">appendix D</a> for full evidence tables.</p></div><div id="chc.s1.2.6"><h4>Quality assessment of clinical studies included in the evidence review</h4><p>The included studies were individually assessed using the Critical Appraisal Skills Programme (CASP) tool for clinical prediction rule. Studies were rated as of moderate or high quality. The reasons for rating down the quality of the studies were that the tool had not been validated in a different population, or that the tool did not include all the relevant prognostic factors.</p><p>The clinical evidence profiles for this review question (prognostic tools) are presented in <a class="figpopup" href="/books/NBK576822/table/chc.tab6/?report=objectonly" target="object" rid-figpopup="figchctab6" rid-ob="figobchctab6">Table 6</a> to <a class="figpopup" href="/books/NBK576822/table/chc.tab9/?report=objectonly" target="object" rid-figpopup="figchctab9" rid-ob="figobchctab9">Table 9</a>.</p><div id="chc.s1.2.6.1"><h5>Predictive prognostic tool 1: Adjuvant! Online</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab6"><a href="/books/NBK576822/table/chc.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figchctab6" rid-ob="figobchctab6"><img class="small-thumb" src="/books/NBK576822/table/chc.tab6/?report=thumb" src-large="/books/NBK576822/table/chc.tab6/?report=previmg" alt="Table 6. Summary of included studies and results for Adjuvant! Online." /></a><div class="icnblk_cntnt"><h4 id="chc.tab6"><a href="/books/NBK576822/table/chc.tab6/?report=objectonly" target="object" rid-ob="figobchctab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Summary of included studies and results for Adjuvant! Online. </p></div></div></div><div id="chc.s1.2.6.2"><h5>Predictive prognostic tool 2: PREDICT</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab7"><a href="/books/NBK576822/table/chc.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figchctab7" rid-ob="figobchctab7"><img class="small-thumb" src="/books/NBK576822/table/chc.tab7/?report=thumb" src-large="/books/NBK576822/table/chc.tab7/?report=previmg" alt="Table 7. Summary of included studies and results for PREDICT." /></a><div class="icnblk_cntnt"><h4 id="chc.tab7"><a href="/books/NBK576822/table/chc.tab7/?report=objectonly" target="object" rid-ob="figobchctab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Summary of included studies and results for PREDICT. </p></div></div></div><div id="chc.s1.2.6.3"><h5>Predictive prognostic tool 3: Nottingham Prognostic Index (NPI)</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab8"><a href="/books/NBK576822/table/chc.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figchctab8" rid-ob="figobchctab8"><img class="small-thumb" src="/books/NBK576822/table/chc.tab8/?report=thumb" src-large="/books/NBK576822/table/chc.tab8/?report=previmg" alt="Table 8. Summary of included studies and results for Nottingham Prognostic Index (NPI)." /></a><div class="icnblk_cntnt"><h4 id="chc.tab8"><a href="/books/NBK576822/table/chc.tab8/?report=objectonly" target="object" rid-ob="figobchctab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Summary of included studies and results for Nottingham Prognostic Index (NPI). </p></div></div></div><div id="chc.s1.2.6.4"><h5>Predictive prognostic tool 4: FinProg</h5><p>No studies were identified for this prognostic tool.</p></div><div id="chc.s1.2.6.5"><h5>Predictive prognostic tool 5: CancerMath</h5><p>No studies were identified for this prognostic tool.</p></div><div id="chc.s1.2.6.6"><h5>Predictive prognostic tool 6: Oxford Prognostic Index (OPI)</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchctab9"><a href="/books/NBK576822/table/chc.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figchctab9" rid-ob="figobchctab9"><img class="small-thumb" src="/books/NBK576822/table/chc.tab9/?report=thumb" src-large="/books/NBK576822/table/chc.tab9/?report=previmg" alt="Table 9. Summary of included studies and results for Oxford Prognostic Index (OPI)." /></a><div class="icnblk_cntnt"><h4 id="chc.tab9"><a href="/books/NBK576822/table/chc.tab9/?report=objectonly" target="object" rid-ob="figobchctab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Summary of included studies and results for Oxford Prognostic Index (OPI). </p></div></div><p>Full GRADE tables are not available as GRADE is not appropriate to assess the quality of evidence for prediction model performance reviews.</p></div></div><div id="chc.s1.2.7"><h4>Economic evidence</h4><p>A systematic review of the economic literature was conducted but no relevant studies were identified which were applicable to this review question. Economic modelling was not undertaken for this question because other topics were agreed as higher priorities for economic evaluation.</p></div><div id="chc.s1.2.8"><h4>Evidence statements</h4><div id="chc.s1.2.8.1"><h5>Predictive prognostic tool 1: Adjuvant! Online</h5><div id="chc.s1.2.8.1.1"><h5>Critical outcomes</h5><div id="chc.s1.2.8.1.1.1"><h5>Tool calibration - 10-year breast cancer specific survival</h5><p>There was good quality evidence from 1 validation study conducted in the UK with 1065 (data available for n=1058) women with early breast cancer that reported the following:
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<ul id="l487"><li id="lt1257" class="half_rhythm"><div>For the whole cohort (N=1058), Adjuvant! Online showed good calibration (O:E = 0.95). The tool overestimated 10-year breast cancer specific survival by 4.53% (p-value <0.01).</div></li></ul></p><p>The study also reported the calibration according to different factors:</p><div id="chc.s1.2.8.1.1.1.1"><h5>Subgroup: age</h5><ul id="l488"><li id="lt1258" class="half_rhythm"><div>for women aged 20 to 35 (n=34), Adjuvant! Online showed good calibration (O:E = 0.99). This tool overestimated 10-year breast cancer specific survival by 0.67% (p-value: ns);</div></li><li id="lt1259" class="half_rhythm"><div>for women aged 36 to 50 (n=361), Adjuvant! Online showed good calibration (O:E = 0.94). This tool overestimated 10-year breast cancer specific survival by 4.62% (p-value <0.05);</div></li><li id="lt1260" class="half_rhythm"><div>for women aged 51 to 65 (n=454), Adjuvant! Online showed good calibration (O:E = 0.96). This tool overestimated 10-year breast cancer specific survival by 3.51% (p-value: ns);</div></li><li id="lt1261" class="half_rhythm"><div>for women aged 66 to 75 (n=193), Adjuvant! Online showed good calibration (O:E = 0.89). This tool underestimated 10-year breast cancer specific survival by 7.04% (p-value <0.05);</div></li><li id="lt1262" class="half_rhythm"><div>for women aged ≥76 (n=16), Adjuvant! Online showed good calibration (O:E = 0.94). This tool overestimated 10-year breast cancer specific survival by 3.11% (p-value: n.s).</div></li></ul></div><div id="chc.s1.2.8.1.1.1.2"><h5>Subgroup: tumour grade</h5><ul id="l489"><li id="lt1263" class="half_rhythm"><div>for women with grade 1 breast cancer (n=152), Adjuvant! Online showed good calibration (O:E = 0.99). This tool overestimated 10-year breast cancer specific survival by 1.29% (p-value: ns);</div></li><li id="lt1264" class="half_rhythm"><div>for women with grade 2 breast cancer (n=420), Adjuvant! Online showed good calibration (O:E = 0.93). This tool overestimated 10-year breast cancer specific survival by 5.89% (p-value <0.01);</div></li><li id="lt1265" class="half_rhythm"><div>for women with grade 3 breast cancer (n=243), Adjuvant! Online showed good calibration (O:E = 0.92). This tool overestimated 10-year breast cancer specific survival by 6.10% (p-value <0.05);</div></li><li id="lt1266" class="half_rhythm"><div>for women with unknown grade (n=243), Adjuvant! Online showed good calibration (O:E = 0.96). This tool overestimated 10-year breast cancer specific survival by 2.78% (p-value: ns).</div></li></ul></div><div id="chc.s1.2.8.1.1.1.3"><h5>Subgroup: tumour size</h5><ul id="l490"><li id="lt1267" class="half_rhythm"><div>for women with tumour size 0.1 to 1 cm (n=148), Adjuvant! Online showed good calibration (O:E = 0.92). This tool overestimated 10-year breast cancer specific survival by 7.95% (p-value <0.01);</div></li><li id="lt1268" class="half_rhythm"><div>for women with tumour size 1.1 to 2 cm (n=470), Adjuvant! Online showed good calibration (O:E = 0.95). This tool overestimated 10-year breast cancer specific survival by 4.54% (p-value <0.01);</div></li><li id="lt1269" class="half_rhythm"><div>for women with tumour size 2.1 to 5 cm (n=440), Adjuvant! Online showed good calibration (O:E = 0.95). This tool overestimated 10-year breast cancer specific survival by 3.53% (p-value: n.s).</div></li></ul></div><div id="chc.s1.2.8.1.1.1.4"><h5>Subgroup: nodal status</h5><ul id="l491"><li id="lt1270" class="half_rhythm"><div>for women with negative nodal status (n=729), Adjuvant! Online showed good calibration (O:E = 0.96). This tool overestimated 10-year breast cancer specific survival by 3.53% (p-value <0.01);</div></li><li id="lt1271" class="half_rhythm"><div>for women with positive nodal status (n=329), Adjuvant! Online showed good calibration (O:E = 0.91). This tool overestimated 10-year breast cancer specific survival by 6.73% (p-value <0.01).</div></li></ul></div><div id="chc.s1.2.8.1.1.1.5"><h5>Subgroup: ER status</h5><ul id="l492"><li id="lt1272" class="half_rhythm"><div>for women with negative ER status (n=259), Adjuvant! Online showed good calibration (O:E = 0.97). This tool overestimated 10-year breast cancer specific survival by 2.76% (p-value: n.s);</div></li><li id="lt1273" class="half_rhythm"><div>for women with positive ER status (n=491), Adjuvant! Online showed good calibration (O:E = 0.89). This tool overestimated 10-year breast cancer specific survival by 6.62% (p-value <0.01);</div></li><li id="lt1274" class="half_rhythm"><div>for women with unknown ER status (n=308), Adjuvant! Online showed good calibration (O:E = 0.96). This tool overestimated 10-year breast cancer specific survival by 2.74% (p-value: n.s).</div></li></ul></div></div><div id="chc.s1.2.8.1.1.2"><h5>Tool calibration - 10-year overall survival</h5><p>There was good quality evidence from 1 validation study conducted in the UK with 1065 women with early breast cancer that reported the following:
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<ul id="l493"><li id="lt1275" class="half_rhythm"><div>For the whole cohort (N=1065), Adjuvant! Online showed good calibration (O:E = 0.93). The tool overestimated 10-year overall survival by 5.54% (p-value <0.01).</div></li></ul></p><p>The study also reported the tool calibration according to different factors:</p><div id="chc.s1.2.8.1.1.2.1"><h5>Subgroup: age</h5><ul id="l494"><li id="lt1276" class="half_rhythm"><div>for women aged 20 to 35 (n=34), Adjuvant! Online showed good calibration (O:E = 0.97). This tool overestimated 10-year overall survival by 2.27% (p-value: n.s);</div></li><li id="lt1277" class="half_rhythm"><div>for women aged 36 to 50 (n=363), Adjuvant! Online showed good calibration (O:E = 0.95). This tool overestimated 10-year overall survival by 4.33% (p-value <0.05);</div></li><li id="lt1278" class="half_rhythm"><div>for women aged 51 to 65 (n=458), Adjuvant! Online showed good calibration (O:E = 0.95). This tool overestimated 10-year overall survival by 4.02% (p-value <0.05);</div></li><li id="lt1279" class="half_rhythm"><div>for women aged 66 to 75 (n=194), Adjuvant! Online showed good calibration (O:E = 0.82). This tool overestimated 10-year overall survival by 11.17% (p-value <0.01);</div></li><li id="lt1280" class="half_rhythm"><div>for women aged ≥76 (n=16), Adjuvant! Online showed good calibration (O:E = 0.94). This tool underestimated 10-year overall survival by 3.11% (p-value: ns).</div></li></ul></div><div id="chc.s1.2.8.1.1.2.2"><h5>Subgroup: tumour grade</h5><ul id="l495"><li id="lt1281" class="half_rhythm"><div>for women with grade 1 breast cancer (n=152), Adjuvant! Online showed good calibration (O:E = 0.96). This tool overestimated 10-year overall survival by 3.6% (p-value: ns);</div></li><li id="lt1282" class="half_rhythm"><div>for women with grade 2 breast cancer (n=421), Adjuvant! Online showed good calibration (O:E = 0.91). This tool overestimated 10-year overall survival by 7.0% (p-value <0.01);</div></li><li id="lt1283" class="half_rhythm"><div>for women with grade 3 breast cancer (n=248), Adjuvant! Online showed good calibration (O:E = 0.86). This tool overestimated 10-year overall survival by 9.8% (p-value <0.01);</div></li><li id="lt1284" class="half_rhythm"><div>for women with unknown grade (n=244), Adjuvant! Online showed perfect calibration (O:E = 1.00). This tool overestimated 10-year overall survival by 0.2% (p-value: ns).</div></li></ul></div><div id="chc.s1.2.8.1.1.2.3"><h5>Subgroup: tumour size</h5><ul id="l496"><li id="lt1285" class="half_rhythm"><div>for women with tumour size 0.1 to 1 cm (n=150), Adjuvant! Online showed good calibration (O:E = 0.93). This tool overestimated 10-year overall survival by 6.10% (p-value: ns);</div></li><li id="lt1286" class="half_rhythm"><div>for women with tumour size 1.1 to 2 cm (n=471), Adjuvant! Online showed good calibration (O:E = 0.92). This tool overestimated 10-year overall survival by 6.57% (p-value <0.01);</div></li><li id="lt1287" class="half_rhythm"><div>for women with tumour size 2.1 to 5 cm (n=444), Adjuvant! Online showed good calibration (O:E = 0.94). This tool overestimated 10-year overall survival survival by 4.26% (p-value: ns).</div></li></ul></div><div id="chc.s1.2.8.1.1.2.4"><h5>Subgroup: nodal status</h5><ul id="l497"><li id="lt1288" class="half_rhythm"><div>for women with negative nodal status (n=733), Adjuvant! Online showed good calibration (O:E = 0.94). This tool overestimated 10-year overall survival by 4.70% (p-value <0.01);</div></li><li id="lt1289" class="half_rhythm"><div>for women with positive nodal status (n=332), Adjuvant! Online showed good calibration (O:E = 0.89). This tool overestimated 10-year overall survival by 7.38% (p-value <0.01).</div></li></ul></div><div id="chc.s1.2.8.1.1.2.5"><h5>Subgroup: ER status</h5><ul id="l498"><li id="lt1290" class="half_rhythm"><div>for women with negative ER status (n=261), Adjuvant! Online showed good calibration (O:E = 0.97). This tool overestimated 10-year overall survival by 6.57% (p-value: ns);</div></li><li id="lt1291" class="half_rhythm"><div>for women with positive ER status (n=495), Adjuvant! Online showed good calibration (O:E = 0.89). This tool overestimated 10-year overall survival by 4.26% (p-value <0.01);</div></li><li id="lt1292" class="half_rhythm"><div>for women with unknown ER status (n=309), Adjuvant! Online showed good calibration (O:E = 0.96). This tool overestimated 10-year overall survival by 4.26% (p-value: ns).</div></li></ul></div></div><div id="chc.s1.2.8.1.1.3"><h5>Tool discrimination</h5><ul id="l499"><li id="lt1293" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div><div id="chc.s1.2.8.1.2"><h5>Important outcomes</h5><div id="chc.s1.2.8.1.2.1"><h5>Prognostic accuracy (sensitivity, specificity)</h5><ul id="l500"><li id="lt1294" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div></div><div id="chc.s1.2.8.2"><h5>Predictive prognostic tool 2: PREDICT</h5><div id="chc.s1.2.8.2.1"><h5>Critical outcomes</h5><div id="chc.s1.2.8.2.1.1"><h5>Tool calibration and discrimination - 5 year all-cause mortality [PREDICT v1.0]</h5><p>There was moderate quality evidence from 1 validation study conducted in the UK with 5648 women diagnosed with invasive breast cancer that reported the following:
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<ul id="l501"><li id="lt1295" class="half_rhythm"><div>for the whole cohort (N=5468), PREDICT v1.0 showed good calibration (O:E = 0.91). The tool overestimated the number of deaths at 5 years by 1.61%.</div></li></ul></p><p>The study also reported the tool calibration and discrimination according to different factors:</p><div id="chc.s1.2.8.2.1.1.1"><h5>Subgroup: age at diagnosis</h5><ul id="l502"><li id="lt1296" class="half_rhythm"><div>for the women aged <35 (n=108), PREDICT v1.0 showed good calibration (O:E = 0.88). The tool overestimated the number of deaths at 5 years by 2.78%;</div></li><li id="lt1297" class="half_rhythm"><div>for the women aged 35 to 49 (n=1195), PREDICT v1.0 showed good calibration (O:E = 0.83). The tool overestimated the number of deaths at 5 years by 2.68%;</div></li><li id="lt1298" class="half_rhythm"><div>for the women aged 50 to 67 (n=2393), PREDICT v1.0 showed good calibration (O:E = 0.90). The tool overestimated the number of deaths at 5 years by 1.34%;</div></li><li id="lt1299" class="half_rhythm"><div>for the women aged 65 to 74 (n=1101), PREDICT v1.0 showed good calibration (O:E = 0.98). The tool overestimated the number of deaths at 5 years by 0.45%;</div></li><li id="lt1300" class="half_rhythm"><div>for the women aged 75+ (n=671), PREDICT v1.0 showed good calibration (O:E = 0.98). The tool overestimated the number of deaths at 5 years by 0.75%.</div></li></ul></div><div id="chc.s1.2.8.2.1.1.2"><h5>Subgroup: tumour grade</h5><ul id="l503"><li id="lt1301" class="half_rhythm"><div>for women with grade 1 tumour (n=1017), PREDICT v1.0 showed good calibration (O:E = 0.98). The tool overestimated the number of deaths at 5 years by 0.1%;</div></li><li id="lt1302" class="half_rhythm"><div>for women with grade 2 tumour (n=2442), PREDICT v1.0 showed good calibration (O:E = 0.98). The tool overestimated the number of deaths at 5 years by 0.16%;</div></li><li id="lt1303" class="half_rhythm"><div>for women with grade 3 tumour (n=2009), PREDICT v1.0 showed good calibration (O:E = 0.87). The tool overestimated the number of deaths at 5 years by 3.58%.</div></li></ul></div><div id="chc.s1.2.8.2.1.1.3"><h5>Subgroup: tumour size</h5><ul id="l504"><li id="lt1304" class="half_rhythm"><div>for women with tumours <10 mm. (n=485), PREDICT v1.0 showed good calibration (O:E = 0.84). The tool overestimated the number of deaths at 5 years by 1.03%;</div></li><li id="lt1305" class="half_rhythm"><div>for women with tumours 11 to 19 mm. (n=2136), PREDICT v1.0 showed good calibration (O:E = 0.88). The tool overestimated the number of deaths at 5 years by 2.01%;</div></li><li id="lt1306" class="half_rhythm"><div>for women with tumours 20 to 19 mm. (n=1566), PREDICT v1.0 showed good calibration (O:E = 0.94). The tool overestimated the number of deaths at 5 years by 0.96%;</div></li><li id="lt1307" class="half_rhythm"><div>for women with tumours 30 to 49 mm. (n=923), PREDICT v1.0 showed good calibration (O:E = 0.99). The tool overestimated the number of deaths at 5 years by 0.11%;</div></li><li id="lt1308" class="half_rhythm"><div>for women with tumours 50+ mm. (n=358), PREDICT v1.0 showed good calibration (O:E = 0.91). The tool overestimated the number of deaths at 5 years by 3.91%.</div></li></ul></div><div id="chc.s1.2.8.2.1.1.4"><h5>Subgroup: nodal status</h5><ul id="l505"><li id="lt1309" class="half_rhythm"><div>for women with negative nodal status (n=3184), PREDICT v1.0 showed good calibration (O:E = 0.80). The tool overestimated the number of deaths at 5 years by 2.14%;</div></li><li id="lt1310" class="half_rhythm"><div>for women with positive nodal status (n=2284), PREDICT v1.0 showed good calibration (O:E = 0.98). The tool overestimated the number of deaths at 5 years by 0.39%.</div></li></ul></div><div id="chc.s1.2.8.2.1.1.5"><h5>Subgroup: ER status</h5><ul id="l506"><li id="lt1311" class="half_rhythm"><div>for women with negative ER status (n=1116), PREDICT v1.0 showed good calibration (O:E = 0.87). The tool overestimated the number of deaths at 5 years by 4.21%. The tool also showed good discrimination (AUC = 0.81);</div></li><li id="lt1312" class="half_rhythm"><div>for women with positive ER status (n=4352), PREDICT v1.0 showed good calibration (O:E = 0.95). The tool overestimated the number of deaths at 5 years by 0.69%. The tool also showed good discrimination (AUC = 0.75).</div></li></ul></div></div><div id="chc.s1.2.8.2.1.2"><h5>Tool calibration - 5 year all-cause mortality [PREDICT v1.2]</h5><p>There was good quality evidence from 1 validation study conducted in the UK with 3000 women aged ≤40 years at diagnosis that reported the following:
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<ul id="l507"><li id="lt1313" class="half_rhythm"><div>for the whole cohort (N=2827), PREDICT v1.2 showed poor calibration (O:E = 1.33). The tool overestimated the number of deaths at 5 years by 25%. The tool also showed poor discrimination for both ER- (AUC=0.718) and ER+ and (AUC=0.730) groups.</div></li></ul></p><p>The study also reported the calibration according to different factors:</p><div id="chc.s1.2.8.2.1.2.1"><h5>Subgroup: age at diagnosis</h5><ul id="l508"><li id="lt1314" class="half_rhythm"><div>for the women aged 18 to 25 (n=40), PREDICT v1.2 showed poor calibration (O:E = 1.4). The tool underestimated the number of deaths at 5 years by 28.6%;</div></li><li id="lt1315" class="half_rhythm"><div>for the women aged 26 to 30 (n=258), PREDICT v1.2 showed poor calibration (O:E = 1.35). The tool underestimated the number of deaths at 5 years by 25.8%;</div></li><li id="lt1316" class="half_rhythm"><div>for the women aged 31 to 35 (n=864), PREDICT v1.2 showed poor calibration (O:E = 1.38). The tool underestimated the number of deaths at 5 years by 27.6%;</div></li><li id="lt1317" class="half_rhythm"><div>for the women aged 36 to 40 (n=1665), PREDICT v1.2 showed poor calibration (O:E = 1.30). The tool underestimated the number of deaths at 5 years by 23.2%.</div></li></ul></div><div id="chc.s1.2.8.2.1.2.2"><h5>Subgroup: tumour grade</h5><ul id="l509"><li id="lt1318" class="half_rhythm"><div>for women with grade 1 tumour (n=156), PREDICT v1.2 showed poor calibration (O:E = 1.25). The tool underestimated the number of deaths at 5 years by 20%;</div></li><li id="lt1319" class="half_rhythm"><div>for women with grade 2 tumour (n=929), PREDICT v1.2 showed poor calibration (O:E = 2.40). The tool underestimated the number of deaths at 5 years by 58.4%;</div></li><li id="lt1320" class="half_rhythm"><div>for women with grade 3 tumour (n=1676), PREDICT v1.2 showed good calibration (O:E = 1.13). The tool underestimated the number of deaths at 5 years by 11.9%;</div></li><li id="lt1321" class="half_rhythm"><div>for women with unknown grade tumour (n=66), PREDICT v1.2 showed poor calibration (O:E = 1.71). The tool underestimated the number of deaths at 5 years by 41.7%.</div></li></ul></div><div id="chc.s1.2.8.2.1.2.3"><h5>Subgroup: tumour size</h5><ul id="l510"><li id="lt1322" class="half_rhythm"><div>for women with tumours 0 to 10 mm. (n=265), PREDICT v1.2 showed poor calibration (O:E = 2.1). The tool underestimated the number of deaths at 5 years by 52.4%;</div></li><li id="lt1323" class="half_rhythm"><div>for women with tumours 11 to 20 mm. (n=930), PREDICT v1.2 showed poor calibration (O:E = 1.25). The tool underestimated the number of deaths at 5 years by 20%;</div></li><li id="lt1324" class="half_rhythm"><div>for women with tumours 21 to 50 mm. (n=1229), PREDICT v1.2 showed poor calibration (O:E = 1.26). The tool underestimated the number of deaths at 5 years by 22.8%;</div></li><li id="lt1325" class="half_rhythm"><div>for women with tumours >50 mm. (n=244), PREDICT v1.2 showed good calibration (O:E = 1.16). The tool underestimated the number of deaths at 5 years by 14%.</div></li><li id="lt1326" class="half_rhythm"><div>for women with unknown size tumours (n=159), PREDICT v1.2 showed poor calibration (O:E = 2.44). The tool underestimated the number of deaths at 5 years by 59%.</div></li></ul></div><div id="chc.s1.2.8.2.1.2.4"><h5>Subgroup: nodal status</h5><ul id="l511"><li id="lt1327" class="half_rhythm"><div>for women with negative nodal status (n=1370), PREDICT v1.2 showed poor calibration (O:E = 1.26). The tool underestimated the number of deaths at 5 years by 20.5%;</div></li><li id="lt1328" class="half_rhythm"><div>for women with positive nodal status (n=1431), PREDICT v1.2 showed poor calibration (O:E = 1.35). The tool underestimated the number of deaths at 5 years by 26.2%;</div></li><li id="lt1329" class="half_rhythm"><div>for women with unknown nodal status (n=26), PREDICT v1.2 showed poor calibration (O:E = 1.75). The tool underestimated the number of deaths at 5 years by 42.9%.</div></li></ul></div><div id="chc.s1.2.8.2.1.2.5"><h5>Subgroup: ER status</h5><ul id="l512"><li id="lt1330" class="half_rhythm"><div>for women with negative ER status (n=965), PREDICT v1.2 showed good calibration (O:E = 0.82). The tool overestimated the numb er of deaths at 5 years by 21.2%;</div></li><li id="lt1331" class="half_rhythm"><div>for women with unknown ER status (n=1862), PREDICT v1.2 showed poor calibration (O:E = 2.29). The tool underestimated the number of deaths at 5 years by 56.4%.</div></li></ul></div><div id="chc.s1.2.8.2.1.2.6"><h5>Subgroup: HER2 status</h5><ul id="l513"><li id="lt1332" class="half_rhythm"><div>for women with negative HER2 status (n=1773), PREDICT v1.2 showed poor calibration (O:E = 1.50). The tool underestimated the number of deaths at 5 years by 33.4%;</div></li><li id="lt1333" class="half_rhythm"><div>for women with positive HER2 status (n=679), PREDICT v1.2 showed good calibration (O:E = 1.15). The tool underestimated the number of deaths at 5 years by 13.1%;</div></li><li id="lt1334" class="half_rhythm"><div>for women with borderline HER2 status (n=40), PREDICT v1.2 showed poor calibration (O:E = 1.67). The tool underestimated the number of deaths at 5 years by 40%;</div></li><li id="lt1335" class="half_rhythm"><div>for women with unknown HER2 status (n=335), PREDICT v1.2 showed good calibration (O:E = 0.88). The tool overestimated the number of deaths at 5 years by 12.9%.</div></li></ul></div></div><div id="chc.s1.2.8.2.1.3"><h5>Tool calibration and discrimination - 8 year all-cause mortality [PREDICT v1.0] (proxy outcome for long term all-cause mortality)</h5><p>There was good moderate evidence from 1 validation study conducted in the UK with 5648 women diagnosed with invasive breast cancer that reported the following:
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<ul id="l514"><li id="lt1336" class="half_rhythm"><div>for the whole cohort (N=5468), PREDICT v1.0 showed good calibration (O:E = 0.95) and good discrimination (AUC = 0.79). The tool overestimated the number of deaths at 8 years by 0.93%.</div></li></ul></p><p>The study also reported the tool calibration according to different factors:</p><div id="chc.s1.2.8.2.1.3.1"><h5>Subgroup: age at diagnosis</h5><ul id="l515"><li id="lt1337" class="half_rhythm"><div>for the women aged <35 (n=108), PREDICT v1.0 showed good calibration (O:E = 1.08) but poor discrimination (AUC = 0.70). The tool underestimated the number of deaths at 8 years by 1.85%;</div></li><li id="lt1338" class="half_rhythm"><div>for the women aged 35 to 49 (n=1195), PREDICT v1.0 showed good calibration (O:E = 0.87) and good discrimination (AUC = 0.79). The tool overestimated the number of deaths at 8 years by 2.18%;</div></li><li id="lt1339" class="half_rhythm"><div>for the women aged 50 to 67 (n=2393), PREDICT v1.0 showed good calibration (O:E = 0.92) and good discrimination (AUC = 0.80). The tool overestimated the number of deaths at 8 years by 0.09%;</div></li><li id="lt1340" class="half_rhythm"><div>for the women aged 65 to 74 (n=1101), PREDICT v1.0 showed good calibration (O:E ≈ 1.00) and good discrimination (AUC = 0.76). The tool underestimated the number of deaths at 8 years by 0.45%;</div></li><li id="lt1341" class="half_rhythm"><div>for the women aged 75+ (n=671), PREDICT v1.0 showed good calibration (O:E = 0.98) but poor discrimination (AUC = 0.72). The tool overestimated the number of deaths at 8 years by 0.6%.</div></li></ul></div><div id="chc.s1.2.8.2.1.3.2"><h5>Subgroup: tumour grade</h5><ul id="l516"><li id="lt1342" class="half_rhythm"><div>for women with grade 1 tumour (n=1017), PREDICT v1.0 showed good calibration (O:E = 1.04) and good discrimination (AUC = 0.79). The tool underestimated the number of deaths at 8 years by 0.29%;</div></li><li id="lt1343" class="half_rhythm"><div>for women with grade 2 tumour (n=2442), PREDICT v1.0 showed good calibration (O:E = 1.04) and good discrimination (AUC = 0.77). The tool underestimated the number of deaths at 8 years by 0.61%;</div></li><li id="lt1344" class="half_rhythm"><div>for women with grade 3 tumour (n=2009), PREDICT v1.0 showed good calibration (O:E = 0.88) and good discrimination (AUC = 0.75). The tool overestimated the number of deaths at 8 years by 3.38%.</div></li></ul></div><div id="chc.s1.2.8.2.1.3.3"><h5>Subgroup: tumour size</h5><ul id="l517"><li id="lt1345" class="half_rhythm"><div>for women with tumours <10 mm. (n=485), PREDICT v1.0 showed good calibration (O:E = 0.85) and good discrimination (AUC = 0.82). The tool overestimated the number of deaths at 8 years by 1.03%;</div></li><li id="lt1346" class="half_rhythm"><div>for women with tumours 11 to 19 mm. (n=2136), PREDICT v1.0 showed good calibration (O:E = 0.84) and good discrimination (AUC = 0.76). The tool overestimated the number of deaths at 8 years by 1.73%;</div></li><li id="lt1347" class="half_rhythm"><div>for women with tumours 20 to 19 mm. (n=1566), PREDICT v1.0 showed good calibration (O:E = 0.97) but poor discrimination (AUC = 0.71). The tool overestimated the number of deaths at 8 years by 0.57%;</div></li><li id="lt1348" class="half_rhythm"><div>for women with tumours 30 to 49 mm. (n=923), PREDICT v1.0 showed good calibration (O:E = 0.98) but poor discrimination (AUC = 0.72). The tool overestimated the number of deaths at 8 years by 0.43%;</div></li><li id="lt1349" class="half_rhythm"><div>for women with tumours 50+ mm. (n=358), PREDICT v1.0 showed poor calibration (O:E = 0.56) and poor discrimination (AUC = 0.72). The tool overestimated the number of deaths at 8 years by 3.35%.</div></li></ul></div><div id="chc.s1.2.8.2.1.3.4"><h5>Subgroup: nodal status</h5><ul id="l518"><li id="lt1350" class="half_rhythm"><div>for women with negative nodal status (n=3184), PREDICT v1.0 showed good calibration (O:E = 0.84) but poor discrimination (AUC = 0.74). The tool overestimated the number of deaths at 8 years by 1.76%;</div></li><li id="lt1351" class="half_rhythm"><div>for women with positive nodal status (n=2284), PREDICT v1.0 showed good calibration (O:E = 1.01) and good discrimination (AUC = 0.75). The tool underestimated the number of deaths at 8 years by 0.26%.</div></li></ul></div><div id="chc.s1.2.8.2.1.3.5"><h5>Subgroup: ER status</h5><ul id="l519"><li id="lt1352" class="half_rhythm"><div>for women with negative ER status (n=1116), PREDICT v1.0 showed good calibration (O:E = 0.90) and good discrimination (AUC = 0.76). The tool overestimated the number of deaths at 8 years by 3.49%;</div></li><li id="lt1353" class="half_rhythm"><div>for women with positive ER status (n=4352), PREDICT v1.0 showed good calibration (O:E = 0.98) and good discrimination (AUC = 0.78). The tool overestimated the number of deaths at 8 years by 0.25%.</div></li></ul></div></div><div id="chc.s1.2.8.2.1.4"><h5>Tool calibration and discrimination - 10 year all-cause mortality [PREDICT v1.2]</h5><p>There was good quality evidence from 1 validation study conducted in the UK with 3000 women aged ≤40 years at diagnosis that reported the following:
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<ul id="l520"><li id="lt1354" class="half_rhythm"><div>for the whole cohort (N=597), PREDICT v1.2 showed good calibration (O:E = 0.93). The tool overestimated the number of deaths at 10 years by 7.9%.</div></li></ul></p><p>The study also reported the tool calibration and discrimination according to different factors:</p><div id="chc.s1.2.8.2.1.4.1"><h5>Subgroup: age at diagnosis</h5><ul id="l521"><li id="lt1355" class="half_rhythm"><div>for the women aged 18 to 25 (n=8), PREDICT v1.2 showed perfect calibration (O:E = 1);</div></li><li id="lt1356" class="half_rhythm"><div>for the women aged 26 to 30 (n=55), PREDICT v1.2 showed good calibration (O:E = 0.94). The tool overestimated the number of deaths at 10 years by 6.7%;</div></li><li id="lt1357" class="half_rhythm"><div>for the women aged 31 to 35 (n=203), PREDICT v1.2 showed good calibration (O:E = 1.05). The tool underestimated the number of deaths at 10 years by 5%;</div></li><li id="lt1358" class="half_rhythm"><div>for the women aged 36 to 40 (n=331), PREDICT v1.2 showed good calibration (O:E = 0.84). The tool overestimated the number of deaths at 10 years by 18.4%.</div></li></ul></div><div id="chc.s1.2.8.2.1.4.2"><h5>Subgroup: tumour grade</h5><ul id="l522"><li id="lt1359" class="half_rhythm"><div>for women with grade 1 tumour (n=31), PREDICT v1.2 showed poor calibration (O:E = 1.5). The tool underestimated the number of deaths at 10 years by 33%;</div></li><li id="lt1360" class="half_rhythm"><div>for women with grade 2 tumour (n=200), PREDICT v1.2 showed poor calibration (O:E = 1.42). The tool underestimated the number of deaths at 10 years by 30%;</div></li><li id="lt1361" class="half_rhythm"><div>for women with grade 3 tumour (n=351), PREDICT v1.2 showed good calibration (O:E = 0.80). The tool overestimated the number of deaths at 10 years by 25.5%;</div></li><li id="lt1362" class="half_rhythm"><div>for women with unknown grade tumour (n=15), PREDICT v1.2 showed perfect calibration (O:E = 1).</div></li></ul></div><div id="chc.s1.2.8.2.1.4.3"><h5>Subgroup: tumour size</h5><ul id="l523"><li id="lt1363" class="half_rhythm"><div>for women with tumours 0 to 10 mm. (n=48), PREDICT v1.2 showed poor calibration (O:E = 2). The tool underestimated the number of deaths at 10 years by 50%;</div></li><li id="lt1364" class="half_rhythm"><div>for women with tumours 11 to 20 mm. (n=221), PREDICT v1.2 showed good calibration (O:E = 0.91). The tool overestimated the number of deaths at 10 years by 9.8%;</div></li><li id="lt1365" class="half_rhythm"><div>for women with tumours 21 to 50 mm. (n=244), PREDICT v1.2 showed good calibration (O:E = 0.99). The tool overestimated the number of deaths at 10 years by 1.3%;</div></li><li id="lt1366" class="half_rhythm"><div>for women with tumours >50 mm. (n=54), PREDICT v1.2 showed poor calibration (O:E = 0.46). The tool overestimated the number of deaths at 10 years by 115.4%;</div></li><li id="lt1367" class="half_rhythm"><div>for women with unknown size tumours (n=30), PREDICT v1.2 showed good calibration (O:E = 1.2). The tool underestimated the number of deaths at 5 years by 16.7%.</div></li></ul></div><div id="chc.s1.2.8.2.1.4.4"><h5>Subgroup: node status</h5><ul id="l524"><li id="lt1368" class="half_rhythm"><div>for women with negative nodal status (n=266), PREDICT v1.2 showed good calibration (O:E = 0.93). The tool overestimated the number of deaths at 10 years by 7.7%;</div></li><li id="lt1369" class="half_rhythm"><div>for women with positive nodal status (n=327), PREDICT v1.2 showed good calibration (O:E = 0.92). The tool overestimated the number of deaths at 10 years by 8%;</div></li><li id="lt1370" class="half_rhythm"><div>for women with unknown nodal status (n=4), PREDICT v1.2 showed perfect calibration (O:E = 1).</div></li></ul></div><div id="chc.s1.2.8.2.1.4.5"><h5>Subgroup: ER status</h5><ul id="l525"><li id="lt1371" class="half_rhythm"><div>for women with negative ER status (n=231), PREDICT v1.2 showed poor calibration (O:E = 0.68). The tool overestimated the number of deaths at 10 years by 46.9%. The tool also showed poor discrimination (AUC=0.694);</div></li><li id="lt1372" class="half_rhythm"><div>for women with unknown ER status (n=366), PREDICT v1.2 showed poor calibration (O:E = 1.26). The tool underestimated the number of deaths at 10 years by 20.5%. The tool also showed poor discrimination (AUC=0.694).</div></li></ul></div><div id="chc.s1.2.8.2.1.4.6"><h5>Subgroup: HER2 status</h5><ul id="l526"><li id="lt1373" class="half_rhythm"><div>for women with negative HER2 status (n=327), PREDICT v1.2 showed good calibration (O:E = 0.99). The tool overestimated the number of deaths at 10 years by 1.2%. However the tool showed poor discrimination (AUC=0.724);</div></li><li id="lt1374" class="half_rhythm"><div>for women with positive HER2 status (n=140), PREDICT v1.2 showed good calibration (O:E = 0.94). The tool overestimated the number of deaths at 10 years by 6%. However the tool showed poor discrimination (AUC=0.592);</div></li><li id="lt1375" class="half_rhythm"><div>for women with borderline HER2 status (n=14), PREDICT v1.2 showed poor calibration (O:E = 1.25). The tool underestimated the number of deaths at 10 years by 20%;</div></li><li id="lt1376" class="half_rhythm"><div>for women with unknown HER2 status (n=116), PREDICT v1.2 showed poor calibration (O:E = 0.62). The tool overestimated the number of deaths at 10 years by 60%.</div></li></ul></div></div><div id="chc.s1.2.8.2.1.5"><h5>Tool calibration and discrimination - 10 year breast cancer mortality [PREDICT v1.1 and v1.2]</h5><p>There was good quality evidence from 1 validation study conducted in the UK with 1726 cases of invasive breast cancer and ER+ that reported the following:
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<ul id="l527"><li id="lt1377" class="half_rhythm"><div>for the whole cohort (N=1726), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.13 and 1.08 respectively). The tool also showed good discrimination [AUC = 0.7611 and 0.7676 respectively – (p-value = 0.0008)].</div></li></ul></p><p>The study also reported the tool calibration according to different factors:</p><div id="chc.s1.2.8.2.1.5.1"><h5>Subgroup: age</h5><ul id="l528"><li id="lt1378" class="half_rhythm"><div>for the women aged <40 (n=67), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.15 and 1.07 respectively);</div></li><li id="lt1379" class="half_rhythm"><div>for the women aged 40 to 49 (n=274), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.18 and 1.13 respectively);</div></li><li id="lt1380" class="half_rhythm"><div>for the women aged 50 to 59 (n=436), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.18 and 1.15 respectively);</div></li><li id="lt1381" class="half_rhythm"><div>for the women aged 60+ (n=497), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.06 and 1.01 respectively).</div></li></ul></div><div id="chc.s1.2.8.2.1.5.2"><h5>Subgroup: tumour size</h5><ul id="l529"><li id="lt1382" class="half_rhythm"><div>for women with tumours <10 mm (n=144), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 0.78 and 0.78 respectively);</div></li><li id="lt1383" class="half_rhythm"><div>for the women with tumours 10 to 19 mm (n=574), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.09 and 1.05 respectively);</div></li><li id="lt1384" class="half_rhythm"><div>for the women with tumours 20 to 29 mm (n=404), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 1.32 and 1.26 respectively);</div></li><li id="lt1385" class="half_rhythm"><div>for the women with tumours 30 to 49 mm (n=140), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 0.95 and 0.91 respectively);</div></li><li id="lt1386" class="half_rhythm"><div>for the women with tumours 50+ mm (n=11), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 0.5 and 0.5 respectively).</div></li><li id="lt1387" class="half_rhythm"><div>for the women with tumours of unknown size (n=1), both PREDICT v1.1 and PREDICT v1.2 showed perfect calibration (O:E = 1 and 1 respectively).</div></li></ul></div><div id="chc.s1.2.8.2.1.5.3"><h5>Subgroup: nodal status</h5><ul id="l530"><li id="lt1388" class="half_rhythm"><div>for women with negative nodal status (n=709), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.19 and 1.15 respectively);</div></li><li id="lt1389" class="half_rhythm"><div>for the women with 1+ nodes (n=241), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 1.23 and 1.17 respectively);</div></li><li id="lt1390" class="half_rhythm"><div>for the women with 2 to 4+ nodes (n=184), PREDICT v1.1 showed good calibration (O:E = 1.05) and PREDICT v1.2 showed perfect calibration (O:E = 1);</div></li><li id="lt1391" class="half_rhythm"><div>for the women with 5 to 9+ nodes (n=37), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.10 and 1.05 respectively);</div></li><li id="lt1392" class="half_rhythm"><div>for the women with 10+ nodes (n=6), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 0.8 and 0.8 respectively).</div></li><li id="lt1393" class="half_rhythm"><div>for the women with unknown nodal status (n=97), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.07 and 1.07 respectively).</div></li></ul></div><div id="chc.s1.2.8.2.1.5.4"><h5>Subgroup: grade</h5><ul id="l531"><li id="lt1394" class="half_rhythm"><div>for women with grade 1 breast cancer (n=235), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 1.8 and 1.8 respectively);</div></li><li id="lt1395" class="half_rhythm"><div>for the women with grade 2 breast cancer (n=528), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.16 and 1.14 respectively);</div></li><li id="lt1396" class="half_rhythm"><div>for the women with grade 3 breast cancer (n=395), both PREDICT v1.1 and PREDICT v1.2 showed good calibration (O:E = 1.14 and 1.07 respectively);</div></li><li id="lt1397" class="half_rhythm"><div>for the women with unknown graded (n=116), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 0.31 and 0.31 respectively).</div></li></ul></div><div id="chc.s1.2.8.2.1.5.5"><h5>Subgroup: HER2 status</h5><ul id="l532"><li id="lt1398" class="half_rhythm"><div>for women with negative HER2 status (n=792), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 1.35 and 1.29 respectively);</div></li><li id="lt1399" class="half_rhythm"><div>for the women with positive HER2 status (n=77), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 1.35 and 1.24 respectively);</div></li><li id="lt1400" class="half_rhythm"><div>for the women with unknown HER2 status (n=405), both PREDICT v1.1 and PREDICT v1.2 showed poor calibration (O:E = 0.44 and 0.44 respectively).</div></li></ul></div></div><div id="chc.s1.2.8.2.1.6"><h5>Tool discrimination and collaboration - 10-year breast cancer mortality [PREDICT 2.0]</h5><p>There was good evidence from 1 validation study conducted with combined data sets (N=5316) that assessed the tool calibration and discrimination of a new version of PREDICT.</p><p>The tool calibration was reported according to different factors, and segregated by ER status (total cohort data was not reported).</p><div id="chc.s1.2.8.2.1.6.1"><h5>Subgroup: age at diagnosis (segregated by ER- and ER+)</h5><div id="chc.s1.2.8.2.1.6.1.1"><h5>ER-</h5><ul id="l533"><li id="lt1401" class="half_rhythm"><div>for the women aged 20 to 29 and negative ER status (n=92), PREDICT v2.0 showed good calibration (O:E = 0.94). The tool overestimated breast cancer mortality by 6%;</div></li><li id="lt1402" class="half_rhythm"><div>for the women aged 30 to 39 and negative ER status (n=855), PREDICT v2.0 showed good calibration (O:E = 0.92). The tool overestimated breast cancer mortality by 9%;</div></li><li id="lt1403" class="half_rhythm"><div>for the women aged 40 to 49 and negative ER status (n=414), PREDICT v2.0 showed good calibration (O:E = 0.98). The tool overestimated breast cancer mortality by 2%;</div></li><li id="lt1404" class="half_rhythm"><div>for the women aged 50 to 59 and negative ER status (n=165), PREDICT v2.0 showed good calibration (O:E = 0.97). The tool overestimated breast cancer mortality by 3%;</div></li><li id="lt1405" class="half_rhythm"><div>for the women aged 60 to 69 and negative ER status (n=117), PREDICT v2.0 showed good calibration (O:E = 0.82). The tool overestimated breast cancer mortality by 21%;</div></li><li id="lt1406" class="half_rhythm"><div>for the women aged 70 to 79 and negative ER status (n=11), PREDICT v2.0 showed poor calibration (O:E = 0.36). The tool overestimated breast cancer mortality by 180%.</div></li></ul></div><div id="chc.s1.2.8.2.1.6.1.2"><h5>ER+</h5><ul id="l534"><li id="lt1407" class="half_rhythm"><div>for the women aged 20 to 29 and positive ER status (n=140), PREDICT v2.0 showed poor calibration (O:E = 0.71). The tool overestimated breast cancer mortality by 40%;</div></li><li id="lt1408" class="half_rhythm"><div>for the women aged 30 to 39 and positive ER status (n=1633), PREDICT v2.0 showed good calibration (O:E = 0.96). The tool overestimated breast cancer mortality by 4%;</div></li><li id="lt1409" class="half_rhythm"><div>for the women aged 40 to 49 and positive ER status (n=1063), PREDICT v2.0 showed good calibration (O:E = 0.90). The tool overestimated breast cancer mortality by 11%;</div></li><li id="lt1410" class="half_rhythm"><div>for the women aged 50 to 59 and positive ER status (n=467), PREDICT v2.0 showed good calibration (O:E = 0.96). The tool overestimated breast cancer mortality by 4%;</div></li><li id="lt1411" class="half_rhythm"><div>for the women aged 60 to 69 and positive ER status (n=517), PREDICT v2.0 showed good calibration (O:E = 1.08). The tool underestimated breast cancer mortality by 7%;</div></li><li id="lt1412" class="half_rhythm"><div>for the women aged 70 to 79 and positive ER status (n=55), PREDICT v2.0 showed poor calibration (O:E = 0.38). The tool overestimated breast cancer mortality by 26%.</div></li></ul></div></div><div id="chc.s1.2.8.2.1.6.2"><h5>Subgroup: tumour size (segregated by ER- and ER+)</h5><div id="chc.s1.2.8.2.1.6.2.1"><h5>ER-</h5><ul id="l535"><li id="lt1413" class="half_rhythm"><div>for women with tumours 0 to 9 mm and negative ER status (n=96), PREDICT v2.0 showed good calibration (O:E = 0.90). The tool overestimated breast cancer mortality by 10%;</div></li><li id="lt1414" class="half_rhythm"><div>for women with tumours 10 to 19 mm and negative ER status (n=559), PREDICT v2.0 showed good calibration (O:E = 0.92). The tool overestimated breast cancer mortality by 8%;</div></li><li id="lt1415" class="half_rhythm"><div>for women with tumours 20 to 29 mm and negative ER status (n=524), PREDICT v2.0 showed good calibration (O:E = 0.97). The tool overestimated breast cancer mortality by 3%;</div></li><li id="lt1416" class="half_rhythm"><div>for women with tumours 30 to 49 mm and negative ER status (n=354), PREDICT v2.0 showed good calibration (O:E = 0.99). The tool overestimated breast cancer mortality by 1%;</div></li><li id="lt1417" class="half_rhythm"><div>for women with tumours 50+ mm and negative ER status (n=121), PREDICT v2.0 showed poor calibration (O:E = 0.75). The tool overestimated breast cancer mortality by 33%.</div></li></ul></div><div id="chc.s1.2.8.2.1.6.2.2"><h5>ER+</h5><ul id="l536"><li id="lt1418" class="half_rhythm"><div>for women with tumours 0 to 9 mm and positive ER status (n=352), PREDICT v2.0 showed poor calibration (O:E = 1.54). The tool underestimated breast cancer mortality by 6%;</div></li><li id="lt1419" class="half_rhythm"><div>for women with tumours 10 to 19 mm and negative ER status (n=1428), PREDICT v2.0 showed good calibration (O:E = 1.06). The tool underestimated breast cancer mortality by 8%;</div></li><li id="lt1420" class="half_rhythm"><div>for women with tumours 20 to 29 mm and positive ER status (n=1111), PREDICT v2.0 showed good calibration (O:E = 0.98). The tool overestimated breast cancer mortality by 0.80%;</div></li><li id="lt1421" class="half_rhythm"><div>for women with tumours 30 to 49 mm and positive ER status (n=695), PREDICT v2.0 showed good calibration (O:E = 0.87). The tool overestimated breast cancer mortality by 15%;</div></li><li id="lt1422" class="half_rhythm"><div>for women with tumours 50+ mm and positive ER status (n=289), PREDICT v2.0 showed poor calibration (O:E = 0.74). The tool overestimated breast cancer mortality by 35%.</div></li></ul></div></div><div id="chc.s1.2.8.2.1.6.3"><h5>Subgroup: number of positive nodes (segregated by ER- and ER+)</h5><div id="chc.s1.2.8.2.1.6.3.1"><h5>ER-</h5><ul id="l537"><li id="lt1423" class="half_rhythm"><div>for women with 0 positive nodes and negative ER status (n=937), PREDICT v2.0 showed good calibration (O:E = 1.01). The tool underestimated breast cancer mortality by 0.89%;</div></li><li id="lt1424" class="half_rhythm"><div>for women with 1 positive node and negative ER status (n=232), PREDICT v2.0 showed good calibration (O:E = 0.86). The tool overestimated breast cancer mortality by 17%;</div></li><li id="lt1425" class="half_rhythm"><div>for women with 2 to 4 positive nodes and negative ER status (n=300), PREDICT v2.0 showed good calibration (O:E = 0.88). The tool overestimated breast cancer mortality by 13%;</div></li><li id="lt1426" class="half_rhythm"><div>for women with 5 to 9 positive nodes and negative ER status (n=101), PREDICT v2.0 showed good calibration (O:E = 0.96). The tool overestimated breast cancer mortality by 4%;</div></li><li id="lt1427" class="half_rhythm"><div>for women with 10+ positive nodes and negative ER status (n=84), PREDICT v2.0 showed good calibration (O:E = 0.85). The tool overestimated breast cancer mortality by 17%.</div></li></ul></div><div id="chc.s1.2.8.2.1.6.3.2"><h5>ER+</h5><ul id="l538"><li id="lt1428" class="half_rhythm"><div>for women with 0 positive nodes and positive ER status (n=2085), PREDICT v2.0 showed good calibration (O:E = 0.99). The tool overestimated breast cancer mortality by 1%;</div></li><li id="lt1429" class="half_rhythm"><div>for women with 1 positive node and positive ER status (n=675), PREDICT v2.0 showed good calibration (O:E = 0.92). The tool overestimated breast cancer mortality by 9%;</div></li><li id="lt1430" class="half_rhythm"><div>for women with 2 to 4 positive nodes and positive ER status (n=734), PREDICT v2.0 showed good calibration (O:E = 0.96). The tool overestimated breast cancer mortality by 4%;</div></li><li id="lt1431" class="half_rhythm"><div>for women with 5 to 9 positive nodes and positive ER status (n=245), PREDICT v2.0 showed good calibration (O:E = 0.86). The tool overestimated breast cancer mortality by 17%;</div></li><li id="lt1432" class="half_rhythm"><div>for women with 10+ positive nodes and positive ER status (n=136), PREDICT v2.0 showed good calibration (O:E = 0.87). The tool overestimated breast cancer mortality by 15%.</div></li></ul></div></div><div id="chc.s1.2.8.2.1.6.4"><h5>Subgroup: tumour grade (segregated by ER- and ER+)</h5><div id="chc.s1.2.8.2.1.6.4.1"><h5>ER-</h5><ul id="l539"><li id="lt1433" class="half_rhythm"><div>for women with grade 1 tumour and negative ER status (n=44), PREDICT v2.0 showed good calibration (O:E = 0.96). The tool overestimated breast cancer mortality by 4%;</div></li><li id="lt1434" class="half_rhythm"><div>for women with grade 2 tumour and negative ER status (n=183), PREDICT v2.0 showed good calibration (O:E = 0.86). The tool overestimated breast cancer mortality by 17%;</div></li><li id="lt1435" class="half_rhythm"><div>for women with grade 3 tumour and negative ER status (n=1427), PREDICT v2.0 showed good calibration (O:E = 0.94). The tool overestimated breast cancer mortality by 7%.</div></li></ul></div><div id="chc.s1.2.8.2.1.6.4.2"><h5>ER+</h5><ul id="l540"><li id="lt1436" class="half_rhythm"><div>for women with grade 1 tumour and positive ER status (n=658), PREDICT v2.0 showed good calibration (O:E = 0.96). The tool overestimated breast cancer mortality by 4%;</div></li><li id="lt1437" class="half_rhythm"><div>for women with grade 2 tumour and positive ER status (n=1730), PREDICT v2.0 showed good calibration (O:E = 0.86). The tool overestimated breast cancer mortality by 17%;</div></li><li id="lt1438" class="half_rhythm"><div>for women with grade 3 tumour and positive ER status (n=1487), PREDICT v2.0 showed good calibration (O:E = 0.94). The tool overestimated breast cancer mortality by 7%.</div></li></ul><p>Tool discrimination was also reported by ER status:
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|
<ul id="l541"><li id="lt1439" class="half_rhythm"><div>for women with negative ER status, the tool discrimination was poor (AUC=0.696);</div></li><li id="lt1440" class="half_rhythm"><div>however for women with positive ER status, the tool discrimination was good (AUC=0.790).</div></li></ul></p></div></div></div></div><div id="chc.s1.2.8.2.2"><h5>Important outcomes</h5><div id="chc.s1.2.8.2.2.1"><h5>Prognostic accuracy (sensitivity, specificity)</h5><ul id="l542"><li id="lt1441" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div></div><div id="chc.s1.2.8.3"><h5>Predictive prognostic tool 3: Nottingham Prognostic Index (NPI)</h5><div id="chc.s1.2.8.3.1"><h5>Critical outcomes</h5><div id="chc.s1.2.8.3.1.1"><h5>Tool calibration - 10-year breast cancer survival</h5><p>There was good quality evidence from 1 validation study conducted in the UK with 2238 women diagnosed with or treated for primary operable invasive breast cancer that reported the following:
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|
<ul id="l543"><li id="lt1442" class="half_rhythm"><div>for women in the excellent prognosis group according to their NPI score (n=320), the tool showed good calibration (O:E = 0.98);</div></li><li id="lt1443" class="half_rhythm"><div>for women in the good prognosis group according to their NPI score (n=475), the tool showed good calibration (O:E = 0.99);</div></li><li id="lt1444" class="half_rhythm"><div>for women in the moderate prognosis group I according to their NPI score (n=634), the tool showed good calibration (O:E = 1.03);</div></li><li id="lt1445" class="half_rhythm"><div>for women in the moderate prognosis group II according to their NPI score (n=489), the tool showed perfect calibration (O:E = 1.00);</div></li><li id="lt1446" class="half_rhythm"><div>for women in the poor prognosis group according to their NPI score (n=233), the tool showed good calibration (O:E = 1.02);</div></li><li id="lt1447" class="half_rhythm"><div>for women in the very poor prognosis group according to their NPI score (n=86), the tool showed good calibration (O:E = 0.89).</div></li></ul></p></div><div id="chc.s1.2.8.3.1.2"><h5>Tool discrimination</h5><ul id="l544"><li id="lt1448" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div><div id="chc.s1.2.8.3.2"><h5>Important outcomes</h5><div id="chc.s1.2.8.3.2.1"><h5>Prognostic accuracy (sensitivity, specificity)</h5><ul id="l545"><li id="lt1449" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div></div><div id="chc.s1.2.8.4"><h5>Predictive prognostic tool 4: FinProg</h5><div id="chc.s1.2.8.4.1"><h5>Critical outcomes</h5><div id="chc.s1.2.8.4.1.1"><h5>Tool calibration</h5><ul id="l546"><li id="lt1450" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div><div id="chc.s1.2.8.4.1.2"><h5>Tool discrimination</h5><ul id="l547"><li id="lt1451" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div><div id="chc.s1.2.8.4.2"><h5>Important outcomes</h5><div id="chc.s1.2.8.4.2.1"><h5>Prognostic accuracy (sensitivity, specificity)</h5><ul id="l548"><li id="lt1452" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div></div><div id="chc.s1.2.8.5"><h5>Predictive prognostic tool 5: CancerMath</h5><div id="chc.s1.2.8.5.1"><h5>Critical outcomes</h5><div id="chc.s1.2.8.5.1.1"><h5>Tool calibration</h5><ul id="l549"><li id="lt1453" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div><div id="chc.s1.2.8.5.1.2"><h5>Tool discrimination</h5><ul id="l550"><li id="lt1454" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div><div id="chc.s1.2.8.5.2"><h5>Important outcomes</h5><div id="chc.s1.2.8.5.2.1"><h5>Prognostic accuracy (sensitivity, specificity)</h5><ul id="l551"><li id="lt1455" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div></div><div id="chc.s1.2.8.6"><h5>Predictive prognostic tool 6: Oxford Prognostic Index (OPI)</h5><div id="chc.s1.2.8.6.1"><h5>Critical outcomes</h5><div id="chc.s1.2.8.6.1.1"><h5>Tool calibration and discrimination - 5-year recurrence-free survival</h5><p>There was moderate quality evidence from 1 validation study with 1787 women treated for invasive ductal carcinoma that reported the following:
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|
<ul id="l552"><li id="lt1456" class="half_rhythm"><div>for the whole cohort (N=1789), OPI showed good calibration (O:E = 1.01). The tool underestimated 5-year recurrence free survival by 0.7%. However the tool showed poor discrimination (overall C-statistic = 0.720).</div></li><li id="lt1457" class="half_rhythm"><div>The study also reported the calibration according to different factors (tool discrimination was not reported):</div></li></ul></p><div id="chc.s1.2.8.6.1.1.1"><h5>Subgroup: age</h5><ul id="l553"><li id="lt1458" class="half_rhythm"><div>for women ≤50 years (n=1097), OPI showed good calibration (O:E = 1.03). The tool underestimated 5-year recurrence free survival by 1.92%;</div></li><li id="lt1459" class="half_rhythm"><div>for women >50 years (n=690), OPI showed perfect calibration (O:E ≈ 1.00). The tool overestimated 5-year recurrence free survival by 0.10%.</div></li></ul></div><div id="chc.s1.2.8.6.1.1.2"><h5>Subgroup: tumour grade</h5><ul id="l554"><li id="lt1460" class="half_rhythm"><div>for women with grade 1 tumour (n=196), OPI showed good calibration (O:E = 1.06). The tool underestimated 5-year recurrence free survival by 5.15%;</div></li><li id="lt1461" class="half_rhythm"><div>for women with grade 2 tumour (n=772), OPI showed good calibration (O:E = 1.03). The tool underestimated 5-year recurrence free survival by 2.44%;</div></li><li id="lt1462" class="half_rhythm"><div>for women with grade 3 tumour (n=819), OPI showed good calibration (O:E = 0.98). The tool overestimated 5-year recurrence free survival by 1.04%.</div></li></ul></div><div id="chc.s1.2.8.6.1.1.3"><h5>Subgroup: tumour size</h5><ul id="l555"><li id="lt1463" class="half_rhythm"><div>for women with tumours ≤2 cm (n=954), OPI showed good calibration (O:E = 1.06). The tool overestimated 5-year recurrence free survival by 0.89%;</div></li><li id="lt1464" class="half_rhythm"><div>for women with tumours >2 cm to ≤5 cm (n=772), OPI showed good calibration (O:E = 0.95). The tool underestimated 5-year recurrence free survival by 2.7%;</div></li><li id="lt1465" class="half_rhythm"><div>for women with tumours >5 cm (n=61), OPI showed good calibration (O:E = 1.04). The tool overestimated 5-year recurrence free survival by 3.71%.</div></li></ul></div><div id="chc.s1.2.8.6.1.1.4"><h5>Subgroup: nodal status</h5><ul id="l556"><li id="lt1466" class="half_rhythm"><div>for women with negative nodal status (n=674), OPI showed good calibration (O:E = 1.02). The tool overestimated 5-year recurrence free survival by 1.82%;</div></li><li id="lt1467" class="half_rhythm"><div>for women with positive nodal status (n=1113), OPI showed good calibration (O:E = 1.01). The tool underestimated 5-year recurrence free survival by 0.71%.</div></li></ul></div><div id="chc.s1.2.8.6.1.1.5"><h5>Subgroup: ER status</h5><ul id="l557"><li id="lt1468" class="half_rhythm"><div>for women with negative ER status (n=1097), OPI showed good calibration (O:E = 1.03). The tool overestimated 5-year recurrence free survival by 1.92%;</div></li><li id="lt1469" class="half_rhythm"><div>for women with positive ER status (n=690), OPI showed perfect calibration (O:E ≈ 1.00). The tool underestimated 5-year recurrence free survival by 0.10%.</div></li></ul></div></div></div><div id="chc.s1.2.8.6.2"><h5>Important outcomes</h5><div id="chc.s1.2.8.6.2.1"><h5>Prognostic accuracy (sensitivity, specificity)</h5><ul id="l558"><li id="lt1470" class="half_rhythm"><div>No evidence was found for this outcome.</div></li></ul></div></div></div></div><div id="chc.s1.2.9"><h4>The committee’s discussion of the evidence</h4><div id="chc.s1.2.9.1"><h5>Interpreting the evidence</h5><div id="chc.s1.2.9.1.1"><h5>The outcomes that matter most</h5><p>The aim of this review was to determine which prognostic prediction tool is most helpful at predicting survival, and therefore identifying women who may benefit from adjuvant treatment.</p><p>The committee agreed that tool calibration and tool discrimination were the critical outcomes for decision making. This is because identifying people with a worse prognosis would guide decisions regarding the use of adjuvant treatment. In addition they also included sensitivity and specificity as important outcomes.</p></div><div id="chc.s1.2.9.1.2"><h5>The quality of the evidence</h5><p>This review included validation studies. The quality of the individual studies was assessed using the CASP tool for clinical prediction rule. The overall judgement of the quality was based on the consideration of the individual domains.</p><p>One study evaluated the Adjuvant! Online tool, and was assessed as high quality.</p><p>Four studies looked at PREDICT. Results were reported separately for each study, as they assessed different versions of PREDICT. Studies using older versions of the tool were rated down because they did not consider all relevant prognostic factors.</p><p>One study evaluated the NPI tool, and was assessed as high quality.</p><p>One study evaluated the OPI tool, and was rated as moderate quality. The main reason for rating down the quality of the study was because the tool is not available in clinical practice, and therefore is of limited use.</p></div><div id="chc.s1.2.9.1.3"><h5>Benefits and drawbacks</h5><p>The committee discussed the benefits and drawbacks of the various tools.</p><p>Four studies reported on the prognostic accuracy of PREDICT, although studies assessed different versions. The results of 1 study showed that the first version of PREDICT (v1.0) was well calibrated to estimate 5-year mortality in the whole cohort, and across different prognostic groups (including age at diagnosis, tumour grade, tumour size, nodal status and ER status). The tool also showed good discrimination for the ER positive and negative models. Likewise, the tool showed good calibration and good discrimination to estimate 8-year mortality in the whole cohort. The tool was well calibrated for all prognostic subgroups, except those with tumours over 50 mm, but it showed poor discrimination for young and old women (those <35 and 75+), those with negative nodal status, and in women with tumours over 20 mm.</p><p>Another study looked at versions v1.1 and v1.2 of PREDICT in women with invasive breast cancer and ER-positive. Results were quite similar for both versions, showing good calibration to estimate 10-year breast cancer mortality in the whole cohort and across most subgroups, the exceptions being those based on tumour size, HER2 status and grade 1 tumours. Discrimination was also good for both versions, but the authors of the study noted that discrimination significantly improved in v1.2.</p><p>Another study that looked at an updated version of PREDICT (v1.2) showed poor calibration and poor discrimination to predict all-cause mortality at 5 years in a cohort of women aged ≤40 years. The tool also showed poor calibration across most prognostic subgroups (including age at diagnosis, tumour grade, tumour size, nodal status, and negative HER2 status). The tool showed good calibration to predict all-cause mortality at 10 years in a cohort of women aged ≤40 years; however there was poor calibration for prognostic subgroups based on tumour grade, tumour size, nodal status and ER status.</p><p>A recent study evaluated the most updated model, PREDICT version 2.0 (version release in 2017). The new tool was shown to have good prognostic accuracy to estimate 10-year breast cancer mortality across most subgroups, including age, tumour size, tumour grade and number of positive nodes, independent of ER status. The committee noted the improved performance of this version of the tool among young women, however calibration was still poor in women aged 20 to 29 who were ER-positive. There was also poor calibration in women aged 70 to 79 and those with tumours greater than 50 mm, independent of ER status, and women with ER-positive tumours smaller than 10 mm.</p><p>The evidence suggested that Adjuvant! Online was a well calibrated tool to predict survival at 10 years. This was shown consistently for the total cohort of women on whom the tool was validated, and for the different subgroups (age, tumour grade, tumour size, nodal status and ER status). This supported the committee’s experience in clinical practice, as they agreed it is a very useful tool. Indeed this tool was extensively used in clinical practice, however they noted this tool is no longer available. Therefore they agreed this tool could not be recommended.</p><p>The evidence suggested that the NPI is also a well calibrated tool to predict 10-year cancer survival. However, the committee agreed it has now been superseded by other tools which take into account more factors such as ER and HER2 status.</p><p>The committee also discussed the results for the OPI. The evidence included in this review suggested that this is a well calibrated tool to predict recurrence-free survival at 5 years for the total cohort of women on whom the tool was validated, and for the different subgroups (age, tumour grade, tumour size, nodal status and ER status). However they noted they were not aware of this tool, as it is not actually available in practice. Based on this they agreed it could not be recommended.</p><p>No studies were found reporting on the prognostic accuracy of CancerMath and FinProg, and the committee agreed they could not make recommendations in favour or against their use.</p><p>The committee agreed that using accurate prognostic tools helps to have more informed decision making, but noted that over-reliance on the results of a prognostic tool could result in over- or under-treatment for some people, if individual characteristics are not taken into consideration (for example significant comorbidities or age group variations).</p><p>In addition they note that as there is limited evidence by population age it is not possible to confirm the accuracy of the tool for all groups. This is because although studies report results by age groups, the sample size for young women is too small to allow sufficient statistical power.</p><p>Overall, the committee agreed that a validated prognostic tool provides important guidance in treatment, but clinical judgement should also play an important role.</p></div></div><div id="chc.s1.2.9.2"><h5>Cost effectiveness and resource use</h5><p>A systematic review of the economic literature was conducted but no relevant studies were identified which were applicable to this review question.</p><p>It was thought that the economic impact of recommendations made in this area would be relatively small because there is little difference in resource use between the prognostic tools (they are freely available and the time taken to complete them is similar).</p><p>The committee have recommended the use of PREDICT which is a change from the previous guideline (CG80), in which Adjuvant! Online was recommended. It might therefore be considered a change in practice. However, in reality most professionals are already using PREDICT because adjuvant! Online is no longer available.</p><p>It is possible that the use of a different tool may have implications for the numbers of patients receiving adjuvant treatment because of differences in prognostic accuracy. Therefore there could be a cost impact associated with changes in patient management. While it is difficult to speculate fully on the direction of this effect, it was considered likely that the scale of the effect would be relatively small and that in most cases the decision on whether to use adjuvant therapy or not would be similar with PREDICT or with Adjuvant! Online.</p></div><div id="chc.s1.2.9.3"><h5>Other factors the committee took into account</h5><p>The committee agreed that this recommendation would make the same prognostic tool available to all populations nationally, and this could potentially reduce inequalities. At the time of guideline publication, PREDICT v2.0 was the version available on the PREDICT homepage (<a href="http://predict.nhs.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://predict.nhs.uk/</a>), although version 1.2 can still be accessed on the website. Although the evidence had considered previous versions of PREDICT, the committee made their recommendations based on PREDICT v2.0. If future versions of PREDICT are released, the recommendations relating to groups in whom the tool is less accurate may no longer be applicable, and this information is provided in a footnote.</p><p>However the committee recognised that the validation of the model may under-represent some ethnic groups. Similarly, this tool has not been validated in men, therefore it is not possible to know if it is applicable to them. They also noted that the very young and older ages are under-represented.</p><p>The committee pointed out that the availability of the prognostic tools affected the recommendations, therefore the long-term adoption of prognostic tools is dependent on continued support and availability.</p><p>Finally the committee highlighted this review did not include gene profiling tools as these will be covered by NICE diagnostic guidance (Gene expression profiling and expanded immunohistochemistry tests for guiding adjuvant chemotherapy decisions in early breast cancer management: MammaPrint, Oncotype DX, IHC4 and Mammostrat; DG10 update), and a link was included to this guidance.</p></div></div><div id="rl.r5"><h4>References</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref1"><p id="p-1285">
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<strong>Blamey 2007</strong>
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</p>Blamey, R. W., Ellis, I. O., Pinder, S. E., Lee, A. H. S., Macmillan, R. D., Morgan, D. A. L., Robertson, J. F. R., Mitchell, M. J., Ball, G. R., Haybittle, J. L., Elston, C. W. (2007) Survival of invasive breast cancer according to the Nottingham Prognostic Index in cases diagnosed in 1990–1999. European journal of cancer, 43, 1548–1555. [<a href="https://pubmed.ncbi.nlm.nih.gov/17321736" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17321736</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref2"><p id="p-1286">
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<strong>Campbell 2009</strong>
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</p>Campbell, H. E., Taylor, M. A., Harris, A. L., Gray, A. M. (2009) An investigation into the performance of the Adjuvant! Online prognostic programme in early breast cancer for a cohort of patients in the United Kingdom. British journal of cancer, 101, 1074–1084. [<a href="/pmc/articles/PMC2768087/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2768087</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19724274" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19724274</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref3"><p id="p-1287">
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<strong>Campbell 2010</strong>
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</p>Campbell, H. E., Gray, A. M., Harris, A. L., Briggs, A. H., Taylor, M. A. (2010) Estimation and external validation of a new prognostic model for predicting recurrence-free survival for early breast cancer patients in the UK. British journal of cancer, 103, 776–786. [<a href="/pmc/articles/PMC2966633/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2966633</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20823886" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20823886</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref4"><p id="p-1288">
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<strong>Candido Dos Reis 2017</strong>
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</p>Candido Dos Reis, F. J., Wishart, G. C., Dicks, E. M., Greenberg, D., Rashbass, J., Schmidt, M. K., van den Broek, A. J., Ellis, I. O., Green, A., Rakha, E., Maishman, T., Eccles, D. M., Pharoah, P. D. P. (2017) An updated PREDICT breast cancer prognostication and treatment benefit prediction model with independent validation. Breast Cancer Research, 19, 58. [<a href="/pmc/articles/PMC5440946/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5440946</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28532503" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28532503</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref5"><p id="p-1289">
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<strong>Debray 2017</strong>
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</p>Debray, T., Damen, J., Snell, K., Ensor, J., Hooft, L., Reitsma, J.
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et al (2017) A guide to systematic review and meta-analysis of prediction model performance. BMJ, 356, i6460. [<a href="https://pubmed.ncbi.nlm.nih.gov/28057641" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28057641</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref6"><p id="p-1290">
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<strong>Maishman 2015</strong>
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</p>Maishman, T., Copson, E., Stanton, L., Gerty, S., Dicks, E., Durcan, L., Wishart, G. C., Pharoah, P., Eccles, D. (2015) An evaluation of the prognostic model PREDICT using the POSH cohort of women aged <40 years at breast cancer diagnosis. British journal of cancer, 112, 983–991. [<a href="/pmc/articles/PMC4366898/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4366898</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25675148" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25675148</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref7"><p id="p-1291">
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<strong>NICE 2009</strong>
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</p>National Institute for Health and Clinical Excellence. (2009). Early and locally advanced breast cancer: diagnosis and treatment. NICE guideline (CG80). [<a href="https://pubmed.ncbi.nlm.nih.gov/19167201" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19167201</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref8"><p id="p-1292">
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<strong>Riley 2015</strong>
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</p>Riley
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RD, Ahmed
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I, Debray
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T, Willis
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BH, Noordzij
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JP, Higgins
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J, Deeks
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JJ. (2015) Summarising and validating test accuracy results across multiple studies for use in clinical practice. Statistics in medicine. 2015
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Jun
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15;34(13):2081–103. [<a href="/pmc/articles/PMC4973708/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4973708</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25800943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25800943</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref9"><p id="p-1293">
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<strong>Wishart 2010</strong>
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</p>Wishart, G. C., Azzato, E. M., Greenberg, D. C., Rashbass, J., Kearins, O., Lawrence, G., Caldas, C., Pharoah, P. D. (2010) PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer. [Erratum appears in Breast Cancer Research 2010;12(2):401]. Breast Cancer Research, 12, R1. [<a href="/pmc/articles/PMC2880419/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2880419</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20053270" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20053270</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="chc.s1.2.ref10"><p id="p-1294">
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<strong>Wishart 2014</strong>
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</p>Wishart, G. C., Rakha, E., Green, A., Ellis, I., Ali, H. R., Provenzano, E., Blows, F. M., Caldas, C., Pharoah, P. D. (2014) Inclusion of KI67 significantly improves performance of the PREDICT prognostication and prediction model for early breast cancer. BMC cancer, 14, 908. [<a href="/pmc/articles/PMC4265394/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4265394</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25472026" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25472026</span></a>]</div></p></li></ul></div></div></div><div id="appendixes.appgroupc"><h2 id="_appendixes_appgroupc_">Appendices</h2><div id="chc.appa"><h3>Appendix A. Review protocols</h3><p id="chc.appa.et1"><a href="/books/NBK576822/bin/chc-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</a><span class="small"> (PDF, 255K)</span></p><p id="chc.appa.et2"><a href="/books/NBK576822/bin/chc-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</a><span class="small"> (PDF, 261K)</span></p></div><div id="chc.appb"><h3>Appendix B. Literature search strategies</h3><div id="chc.appb.s1"><h4>Literature search strategies for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><div id="chc.appb.s1.1"><h5>Database: Medline & Embase (Multifile)</h5><p>Last searched on Embase 1974 to 2017 March 03, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present.</p><p>Date of last search: 6 March 2017.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchcappbtab1"><a href="/books/NBK576822/table/chc.appb.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchcappbtab1" rid-ob="figobchcappbtab1"><img class="small-thumb" src="/books/NBK576822/table/chc.appb.tab1/?report=thumb" src-large="/books/NBK576822/table/chc.appb.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chc.appb.tab1"><a href="/books/NBK576822/table/chc.appb.tab1/?report=objectonly" target="object" rid-ob="figobchcappbtab1">Table</a></h4></div></div></div><div id="chc.appb.s1.2"><h5>Database: Cochrane Library via Wiley Online</h5><p>Date of last search: 6 March 2017.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchcappbtab2"><a href="/books/NBK576822/table/chc.appb.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchcappbtab2" rid-ob="figobchcappbtab2"><img class="small-thumb" src="/books/NBK576822/table/chc.appb.tab2/?report=thumb" src-large="/books/NBK576822/table/chc.appb.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chc.appb.tab2"><a href="/books/NBK576822/table/chc.appb.tab2/?report=objectonly" target="object" rid-ob="figobchcappbtab2">Table</a></h4></div></div></div></div><div id="chc.appb.s2"><h4>Literature search strategies for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><div id="chc.appb.s2.1"><h5>Database: Medline & Embase (Multifile)</h5><p>Last searched on Embase 1974 to 2017 September 20, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present.</p><p>Date of last search: 22 September 2017</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchcappbtab3"><a href="/books/NBK576822/table/chc.appb.tab3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchcappbtab3" rid-ob="figobchcappbtab3"><img class="small-thumb" src="/books/NBK576822/table/chc.appb.tab3/?report=thumb" src-large="/books/NBK576822/table/chc.appb.tab3/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chc.appb.tab3"><a href="/books/NBK576822/table/chc.appb.tab3/?report=objectonly" target="object" rid-ob="figobchcappbtab3">Table</a></h4></div></div></div><div id="chc.appb.s2.2"><h5>Database: Cochrane Library via Wiley Online</h5><p>Date of last search: 22 September 2017.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figchcappbtab4"><a href="/books/NBK576822/table/chc.appb.tab4/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figchcappbtab4" rid-ob="figobchcappbtab4"><img class="small-thumb" src="/books/NBK576822/table/chc.appb.tab4/?report=thumb" src-large="/books/NBK576822/table/chc.appb.tab4/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="chc.appb.tab4"><a href="/books/NBK576822/table/chc.appb.tab4/?report=objectonly" target="object" rid-ob="figobchcappbtab4">Table</a></h4></div></div></div></div></div><div id="chc.appc"><h3>Appendix C. Clinical evidence study selection</h3><div id="chc.appc.s1"><h4>Clinical evidence study selection for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p id="chc.appc.fig1"><a href="/books/NBK576822/figure/chc.appc.fig1/?report=objectonly" target="object" rid-ob="figobchcappcfig1" class="figpopup">Figure 1. Flow diagram of clinical article selection for progesterone receptor testing</a></p></div><div id="chc.appc.s2"><h4>Clinical evidence study selection for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p id="chc.appc.fig2"><a href="/books/NBK576822/figure/chc.appc.fig2/?report=objectonly" target="object" rid-ob="figobchcappcfig2" class="figpopup">Figure 2. Flow diagram of clinical article selection for prognostic tools review</a></p></div></div><div id="chc.appd"><h3>Appendix D. Clinical evidence tables</h3><div id="chc.appd.s1"><h4>Clinical evidence tables for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>There are no clinical evidence tables for this evidence review as no studies met the inclusion criteria.</p></div><div id="chc.appd.s2"><h4>Clinical evidence tables for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p id="chc.appd.et3"><a href="/books/NBK576822/bin/chc-appd-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 10. Clinical evidence tables for 3.2 What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</a><span class="small"> (PDF, 761K)</span></p></div></div><div id="chc.appe"><h3>Appendix E. Forest plots</h3><div id="chc.appe.s1"><h4>Forest plots for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>There are no forest plots for this evidence review as no studies met the inclusion criteria.</p></div><div id="chc.appe.s2"><h4>Forest plots for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p>Forest plots are not applicable to this review as no meta-analysis was undertaken.</p></div></div><div id="chc.appf"><h3>Appendix F. GRADE tables</h3><div id="chc.appf.s1"><h4>GRADE tables for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>There are no GRADE tables for this evidence review as no studies met the inclusion criteria.</p></div><div id="chc.appf.s2"><h4>GRADE tables for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p>There are no GRADE tables for this evidence review as GRADE is not appropriate to assess the quality of evidence for prediction model performance reviews.</p></div></div><div id="chc.appg"><h3>Appendix G. Economic evidence study selection</h3><div id="chc.appg.s1"><h4>Economic evidence study selection for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>See <a href="/books/n/niceng101erbm1/?report=reader" class="toc-item">Supplement 1</a>: Health economics literature review for details of economic study selection.</p></div><div id="chc.appg.s2"><h4>Economic evidence study selection for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p>See <a href="/books/n/niceng101erbm1/?report=reader" class="toc-item">Supplement 1</a>: Health economics literature review for details of economic study selection.</p></div></div><div id="chc.apph"><h3>Appendix H. Economic evidence tables</h3><div id="chc.apph.s1"><h4>Economic evidence tables for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>No economic evidence was identified for this review question.</p></div><div id="chc.apph.s2"><h4>Economic evidence tables for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p>No economic evidence was identified for this review question.</p></div></div><div id="chc.appi"><h3>Appendix I. Health economic evidence profiles</h3><div id="chc.appi.s1"><h4>Health economic evidence profiles for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>No economic evidence was identified for this review question.</p></div><div id="chc.appi.s2"><h4>Health economic evidence profiles for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p>No economic evidence was identified for this review question.</p></div></div><div id="chc.appj"><h3>Appendix J. Health economic analysis</h3><div id="chc.appj.s1"><h4>Health economic analysis for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>No health economic analysis was carried out for this review question.</p></div><div id="chc.appj.s2"><h4>Health economic analysis for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p>No health economic analysis was carried out for this review question.</p></div></div><div id="chc.appk"><h3>Appendix K. Excluded studies</h3><div id="chc.appk.s1"><h4>Excluded studies for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><div id="chc.appk.s1.1"><h5>Clinical studies</h5><p id="chc.appk.et4"><a href="/books/NBK576822/bin/chc-appk-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (247K)</span></p></div><div id="chc.appk.s1.2"><h5>Economic studies for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h5><p>See <a href="/books/n/niceng101erbm1/?report=reader" class="toc-item">Supplement 1</a>: Health economics literature review for list of excluded economic studies.</p></div></div><div id="chc.appk.s2"><h4>Excluded studies for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><div id="chc.appk.s2.1"><h5>Clinical studies</h5><p id="chc.appk.et5"><a href="/books/NBK576822/bin/chc-appk-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (315K)</span></p></div><div id="chc.appk.s2.2"><h5>Economic studies for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h5><p>See <a href="/books/n/niceng101erbm1/?report=reader" class="toc-item">Supplement 1</a>: Health economics literature review for list of excluded economic studies.</p></div></div></div><div id="chc.appl"><h3>Appendix L. Research recommendations</h3><div id="chc.appl.s1"><h4>Research recommendations for 3.1. Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h4><p>No research recommendations were made for this review question.</p></div><div id="chc.appl.s2"><h4>Research recommendations for 3.2. What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy?</h4><p>No research recommendations were made for this review question.</p></div></div><div id="chc.appm"><h3>Appendix M. 3.1 Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h3><p id="chc.appm.et6"><a href="/books/NBK576822/bin/chc-appm-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Nominal group technique questionnaire for progesterone receptor testing</a><span class="small"> (PDF, 240K)</span></p></div><div id="chc.appn"><h3>Appendix N. 3.1 Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning?</h3><div id="chc.appn.s1"><h4>Nominal group technique results</h4><p id="chc.appn.tab1"><a href="/books/NBK576822/table/chc.appn.tab1/?report=objectonly" target="object" rid-ob="figobchcappntab1" class="figpopup">Table 11. Nominal group technique consensus ratings for progesterone receptor testing</a></p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews</p><p>developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2018.</div><div class="small"><span class="label">Bookshelf ID: NBK576822</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35073003" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35073003</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobchctab1"><div id="chc.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICO table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab1_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_chc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chc.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults (18 or over) with invasive breast cancer (M0)</td></tr><tr><th id="hd_b_chc.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_chc.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l213"><li id="lt443" class="half_rhythm"><div>ER and HER2 plus PR test followed by chemotherapy as indicated based on test results</div></li></ul></td></tr><tr><th id="hd_b_chc.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_chc.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l214"><li id="lt444" class="half_rhythm"><div>ER and HER2 test followed by chemotherapy as indicated based on test results</div></li></ul></td></tr><tr><th id="hd_b_chc.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_chc.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<ul id="l215"><li id="lt445" class="half_rhythm"><div>Disease-free survival</div></li><li id="lt446" class="half_rhythm"><div>Overall survival</div></li></ul>
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<b>Important</b>
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<ul id="l216"><li id="lt447" class="half_rhythm"><div>Treatment-related morbidity</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">ER, oestrogen receptor; HER2, human epidermal growth factor receptor-2; M0, no distant metastases; PR, progesterone receptor</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchctab2"><div id="chc.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of nominal group technique process followed for the development of recommendations on progesterone receptor testing</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chc.tab2_1_1_1_1" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Round 1</th><th id="hd_h_chc.tab2_1_1_1_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Round 2</th><th id="hd_h_chc.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of recommendations generated</th></tr></thead><tbody><tr><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Level of consensus</td><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Statements</p>
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<p>N (total = 16)</p>
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</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Level of consensus</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Statements</p>
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<p>N (total = 2)</p>
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</td><td headers="hd_h_chc.tab2_1_1_1_3" rowspan="4" colspan="1" style="text-align:center;vertical-align:top;">1</td></tr><tr><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High (≥80%)</td><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High (≥80%)</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td></tr><tr><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate (60-80%)</td><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate (60-80%)</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td></tr><tr><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low (<60%)</td><td headers="hd_h_chc.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low (<60%)</td><td headers="hd_h_chc.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchctab3"><div id="chc.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Description of the prognostic tools</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Prognostic tool</th><th id="hd_h_chc.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Description</th><th id="hd_h_chc.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Factors included in the model</th></tr></thead><tbody><tr><td headers="hd_h_chc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjuvant! Online</td><td headers="hd_h_chc.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adjuvant! is an online tool that aims to help healthcare professionals and people with early cancer discuss the benefits and risks of receiving additional adjuvant therapy after surgery.</p>
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<p>For further details please see <a href="https://www.adjuvantonline.com/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.adjuvantonline.com/</a></p>
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</td><td headers="hd_h_chc.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adjuvant therapy</p>
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<p>Age</p>
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<p>Comorbidity</p>
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<p>ER status</p>
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<p>Menopausal status</p>
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<p>Number of positive lymph nodes</p>
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<p>Tumour size</p>
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</td></tr><tr><td headers="hd_h_chc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDICT</td><td headers="hd_h_chc.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The PREDICT tool is a free online computer programme developed by the NHS and the University of Cambridge, and it aims to help patients and healthcare professionals decide on the ideal course of treatment following surgery for breast cancer.</p>
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<p>There are different versions of PREDICT (personal communication,):</p>
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<p>v1.0 (2011)</p>
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<p>v1.1 (also known as PREDICT Plus) – modified version of PREDICT v1.0 + HER2</p>
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<p>v1.2 – modified version of PREDICT v1.1 + KI67</p>
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<p>v2.0 (2017) – updated version with substantial modifications to the underlying model</p>
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<p>For further details please see <a href="http://www.predict.nhs.uk/index.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.predict.nhs.uk/index.html</a></p>
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</td><td headers="hd_h_chc.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Age at diagnosis</p>
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<p>ER status</p>
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<p>Gen chemo regimen</p>
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<p>HER2 status</p>
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<p>KI67 status</p>
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<p>Mode of detection</p>
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<p>Number of positive nodes</p>
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<p>Tumour grade</p>
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<p>Tumour size in mm</p>
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</td></tr><tr><td headers="hd_h_chc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nottingham Prognostic Index (NPI)</td><td headers="hd_h_chc.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>The Nottingham prognostic index (NPI) is a tool used to determine prognosis following breast cancer surgery.</p>
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<p>For further details please see <a href="http://www.pmidcalc.org/?sid=3689666&newtest=Y" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.pmidcalc.org<wbr style="display:inline-block"></wbr>​/?sid=3689666&newtest=Y</a></p>
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</td><td headers="hd_h_chc.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Grade of the tumour</p>
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<p>Number of involved lymph nodes</p>
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<p>Size of the lesion</p>
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</td></tr><tr><td headers="hd_h_chc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FinProg</td><td headers="hd_h_chc.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>FinProg is an online-based system for individualised survival estimation in breast cancer.</p>
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<p>For further details please see <a href="http://www.finprog.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.finprog.org/</a></p>
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</td><td headers="hd_h_chc.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adjuvant therapy</p>
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<p>Age</p>
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<p>ER</p>
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<p>HER2</p>
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<p>Histologic grade</p>
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<p>Histologic type</p>
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<p>Lymph node status</p>
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<p>Method of detection</p>
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<p>PR</p>
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<p>Tumour size</p>
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</td></tr><tr><td headers="hd_h_chc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CancerMath</td><td headers="hd_h_chc.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cancer-Math is an online tool aimed to provide healthcare professionals with web-based calculators for: 1) accurately predicting the clinical outcome for people with cancer (including breast cancer), and 2) accurately estimating the impact of various treatment choices on that outcome.</p>
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<p>For further details please see <a href="http://www.lifemath.net/cancer/?cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.lifemath.net/cancer/?cancer</a></p>
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</td><td headers="hd_h_chc.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Age</p>
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<p>Chemotherapy</p>
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<p>ER status</p>
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<p>Grade</p>
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<p>HER2 status</p>
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<p>Histological type</p>
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<p>Hormonal therapy</p>
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<p>Number of positive nodes</p>
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<p>PR status</p>
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<p>Tumour diameter in mm</p>
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</td></tr><tr><td headers="hd_h_chc.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oxford Prognostic Index (OPI)</td><td headers="hd_h_chc.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Oxford Prognostic Index (OPI) is a tool aimed to predict the long-term risk of a recurrent event in women diagnosed with early breast cancer.</td><td headers="hd_h_chc.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Age</p>
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<p>ER status</p>
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<p>Nodal status</p>
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<p>Tumour grade</p>
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<p>Tumour size</p>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">ER: oestrogen receptor; HER2: human epidermal growth factor receptor 2; NPI: Nottingham Prognostic Index; OPI: Oxford Prognostic Index; PR: progesterone receptor</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchctab4"><div id="chc.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Summary of the protocol (PICOTS table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab4_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_chc.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_chc.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Adults (18 or over) with invasive breast cancer (M0) who have undergone surgery and who are candidates for adjuvant systemic therapy.</p>
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<p>Only studies conducted with UK population will be considered for inclusion.</p>
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</td></tr><tr><th id="hd_b_chc.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention (Predictive prognostic tools)</th><td headers="hd_b_chc.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any appropriate predictive prognostic tools, for example,
|
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<ul id="l218"><li id="lt452" class="half_rhythm"><div>Adjuvant! Online</div></li><li id="lt453" class="half_rhythm"><div>PREDICT</div></li><li id="lt454" class="half_rhythm"><div>Nottingham Prognostic Index (NPI)</div></li><li id="lt455" class="half_rhythm"><div>FinProg</div></li><li id="lt456" class="half_rhythm"><div>CancerMath</div></li><li id="lt457" class="half_rhythm"><div>Only studies assessing validated tools will be considered for inclusion.</div></li></ul></td></tr><tr><th id="hd_b_chc.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><td headers="hd_b_chc.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Critical</b>
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<ul id="l219"><li id="lt458" class="half_rhythm"><div>Calibration</div></li><li id="lt459" class="half_rhythm"><div>Discrimination (AUROC)</div></li></ul>
|
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<b>Important</b>
|
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<ul id="l220"><li id="lt460" class="half_rhythm"><div>Accuracy of prediction (sensitivity, specificity)</div></li></ul></td></tr><tr><th id="hd_b_chc.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Timing</th><td headers="hd_b_chc.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l221"><li id="lt461" class="half_rhythm"><div>5 years</div></li><li id="lt462" class="half_rhythm"><div>10 years</div></li></ul></td></tr><tr><th id="hd_b_chc.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Setting</th><td headers="hd_b_chc.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l222"><li id="lt463" class="half_rhythm"><div>UK</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AUROC, area under receiver operating characteristic curve; M0, no distant metastases; NPI, Nottingham prognostic index</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchctab5"><div id="chc.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Predictive prognostic tool</th><th id="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<a class="bibr" href="#chc.s1.2.ref1" rid="chc.s1.2.ref1">Blamey 2007</a>
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</td><td headers="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Women diagnosed with or treated for primary operable invasive breast cancer at Nottingham city hospital</p>
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<p>Dates:
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<ul id="l223"><li id="lt464" class="half_rhythm"><div>1980 to 1986 (n=892)</div></li><li id="lt465" class="half_rhythm"><div>1990 to 1999 (n=2238)</div></li></ul></p>
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</td><td headers="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nottingham Prognostic Index (NPI)</td><td headers="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l224"><li id="lt466" class="half_rhythm"><div>Observed and predicted 10-year breast cancer survival</div></li></ul></td><td headers="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref2" rid="chc.s1.2.ref2">Campbell 2009</a>
|
|
</td><td headers="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Data from 1,065 women with early breast cancer diagnosed at the Churchill hospital Oxford</p>
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<p>Dates: 1986 to 1996</p>
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<p>UK population</p>
|
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</td><td headers="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adjuvant! Online</td><td headers="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul id="l225"><li id="lt467" class="half_rhythm"><div>Observed and predicted 10-year overall survival (%)</div></li><li id="lt468" class="half_rhythm"><div>Observed and predicted 10-year breast cancer specific survival (%)</div></li><li id="lt469" class="half_rhythm"><div>Observed and predicted 10-year event free survival (%)</div></li></ul></td><td headers="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref3" rid="chc.s1.2.ref3">Campbell 2010</a>
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</td><td headers="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>N=1787 women with invasive ductal carcinoma, a sub-set obtained from the Adjuvant Breast Cancer trial from 70 UK centres</p>
|
|
<p>Dates: 1992 to 2000</p>
|
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<p>UK population</p>
|
|
</td><td headers="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oxford Prognostic Index (OPI)</td><td headers="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul id="l226"><li id="lt470" class="half_rhythm"><div>Observed and predicted 5-year recurrence free survival</div></li></ul></td><td headers="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref4" rid="chc.s1.2.ref4">Candido dos Reis 2017</a>
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</td><td headers="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Tool development</p>
|
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<p>Data from 5738 people from the ECRIC database</p>
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<p>Dates: 1999 to 2003</p>
|
|
<p>Validations study</p>
|
|
<p>Data from the following databases:
|
|
<ul id="l227"><li id="lt471" class="half_rhythm"><div>BCOS: n=981 (dates: 1990 to 2000)</div></li><li id="lt472" class="half_rhythm"><div>NTBCS: n=1726 (dates: 1989 to 1998)</div></li><li id="lt473" class="half_rhythm"><div>POSH: n=2609 (dates: 2000 to 2008)</div></li><li id="lt474" class="half_rhythm"><div>UK population</div></li></ul></p>
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</td><td headers="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDICT v2.0<sup>*</sup></td><td headers="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l228"><li id="lt475" class="half_rhythm"><div>Observed and predicted 10-year breast-cancer mortality</div></li><li id="lt476" class="half_rhythm"><div>Observed and predicted 10-year all-cause mortality</div></li></ul></td><td headers="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul id="l229"><li id="lt477" class="half_rhythm"><div>This validation study reports data for PREDICT v2.0 and v1. Data for v1 was not used in the analysis as for many of the cases in the validation data the authors did not have either HER2 status or KI67 status<sup>*</sup></div></li></ul></td></tr><tr><td headers="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref6" rid="chc.s1.2.ref6">Maishman 2015</a>
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</td><td headers="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Data from 3000 women aged ≤40 years at diagnosis (POSH cohort)</p>
|
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<p>UK population</p>
|
|
</td><td headers="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDICT v1.2<sup>*</sup></td><td headers="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l230"><li id="lt478" class="half_rhythm"><div>Observed and predicted 5-year all-cause mortality</div></li><li id="lt479" class="half_rhythm"><div>Observed and predicted 10-year all-cause mortality</div></li></ul></td><td headers="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref9" rid="chc.s1.2.ref9">Wishart 2010</a>
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</td><td headers="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Data from 5468 people with breast cancer from the West Midlands Cancer Intelligence Unit (WMCIU)</p>
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<p>Dates: 1999 to 2003</p>
|
|
<p>UK population</p>
|
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</td><td headers="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDICT v1.1<sup>*</sup></td><td headers="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l231"><li id="lt480" class="half_rhythm"><div>Observed and predicted 5-year all-cause mortality</div></li><li id="lt481" class="half_rhythm"><div>Observed and predicted 8-year all-cause mortality</div></li></ul></td><td headers="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul id="l232"><li id="lt482" class="half_rhythm"><div>Validation study (data from the primary analysis has not been reported)</div></li></ul></td></tr><tr><td headers="hd_h_chc.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref10" rid="chc.s1.2.ref10">Wishart 2014</a>
|
|
</td><td headers="hd_h_chc.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Data for 2232 cases of invasive breast cancer treated in Nottingham - 506 node-negative cases were excluded, so data from n=1726 people was included in the study</p>
|
|
<p>Dates: 1989 to 1998</p>
|
|
<p>UK population</p>
|
|
</td><td headers="hd_h_chc.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PREDICT v1.1<sup>*</sup> and v1.2<sup>*</sup></td><td headers="hd_h_chc.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l233"><li id="lt483" class="half_rhythm"><div>Observed and predicted 10-year all-breast cancer mortality</div></li></ul></td><td headers="hd_h_chc.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>*</dt><dd><div id="chc.tab5_1"><p class="no_margin">This information was provided by PREDICT (<a href="mailto:dev@null" data-email="ku.shn.tciderp@ofni" class="oemail">ku.shn.tciderp@ofni</a>)</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">BCOS, Breast Cancer Outcomes Simulator; ECRIC, East Anglia cancer registration and information centre; NPI, Nottingham Prognostic Index; NTBC, Nottingham Tenovus Breast Cancer; OPI, Oxford Prognostic Index; POSH, Prospective study of Outcomes in Sporadic versus Hereditary breast cancer; UK, United Kingdom; WMCIU, West Midlands Cancer Intelligence Unit</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchctab6"><div id="chc.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Summary of included studies and results for Adjuvant! Online</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_chc.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study details</th><th id="hd_h_chc.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_chc.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Findings</th><th id="hd_h_chc.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th><th id="hd_h_chc.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_chc.tab6_1_1_1_1 hd_h_chc.tab6_1_1_1_2 hd_h_chc.tab6_1_1_1_3 hd_h_chc.tab6_1_1_1_4 hd_h_chc.tab6_1_1_1_5 hd_h_chc.tab6_1_1_1_6" id="hd_b_chc.tab6_1_1_1_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">10-year overall survival (OS)</th></tr><tr><td headers="hd_h_chc.tab6_1_1_1_1 hd_b_chc.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref2" rid="chc.s1.2.ref2">Campbell (2009)</a>
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</td><td headers="hd_h_chc.tab6_1_1_1_2 hd_b_chc.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Validation study</p>
|
|
<p>Study period: 1986 to 1996</p>
|
|
</td><td headers="hd_h_chc.tab6_1_1_1_3 hd_b_chc.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from 1,065 women with early breast cancer diagnosed at the Churchill hospital I Oxford</td><td headers="hd_h_chc.tab6_1_1_1_4 hd_b_chc.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Prognostic accuracy (sensitivity, specificity)</p>
|
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<p>Not reported</p>
|
|
<p>Tool calibration</p>
|
|
<p>All population (N=1065):
|
|
<ul id="l234"><li id="lt484" class="half_rhythm"><div>OS ratio O:E = 0.93</div></li><li id="lt485" class="half_rhythm"><div>Difference O-E = −5.54 (p<0.01)</div></li></ul>
|
|
<i>Subgroup: age</i>
|
|
<ul id="l235"><li id="lt486" class="half_rhythm"><div>20 to 35 (n=34)
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<ul id="l236" class="circle"><li id="lt487" class="half_rhythm"><div>OS ratio O:E = 0.97</div></li><li id="lt488" class="half_rhythm"><div>Difference O-E = −2.27% (ns)</div></li></ul></div></li><li id="lt489" class="half_rhythm"><div>36 to 50 (n=363)
|
|
<ul id="l237" class="circle"><li id="lt490" class="half_rhythm"><div>OS ratio O:E = 0.95</div></li><li id="lt491" class="half_rhythm"><div>Difference O-E = −4.33% (p<0.05)</div></li></ul></div></li><li id="lt492" class="half_rhythm"><div>51 to 65 (n=458)
|
|
<ul id="l238" class="circle"><li id="lt493" class="half_rhythm"><div>OS ratio O:E = 0.95</div></li><li id="lt494" class="half_rhythm"><div>Difference O-E = −4.02% (p<0.05)</div></li></ul></div></li><li id="lt495" class="half_rhythm"><div>66 to 75 (n=194)
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|
<ul id="l239" class="circle"><li id="lt496" class="half_rhythm"><div>OS ratio O:E = 0.82</div></li><li id="lt497" class="half_rhythm"><div>Difference O-E = −12.17% (p<0.01)</div></li></ul></div></li><li id="lt498" class="half_rhythm"><div>≥76 (n=16)
|
|
<ul id="l240" class="circle"><li id="lt499" class="half_rhythm"><div>OS ratio O:E = 0.94</div></li><li id="lt500" class="half_rhythm"><div>Difference O-E = −3.11% (ns)</div></li></ul></div></li></ul>
|
|
<i>Subgroup: grade:</i>
|
|
<ul id="l241"><li id="lt501" class="half_rhythm"><div>Grade 1 (n=152)
|
|
<ul id="l242" class="circle"><li id="lt502" class="half_rhythm"><div>OS ratio O:E: 0.96</div></li><li id="lt503" class="half_rhythm"><div>Difference O-E: - 3.65% (ns)</div></li></ul></div></li><li id="lt504" class="half_rhythm"><div>Grade 2 (n=421)
|
|
<ul id="l243" class="circle"><li id="lt505" class="half_rhythm"><div>OS ratio O:E: 0.91</div></li><li id="lt506" class="half_rhythm"><div>Difference O-E: −7.05% (p<0.01)</div></li></ul></div></li><li id="lt507" class="half_rhythm"><div>Grade 3 (n=248)
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|
<ul id="l244" class="circle"><li id="lt508" class="half_rhythm"><div>OS ratio O:E: 0.86</div></li><li id="lt509" class="half_rhythm"><div>Difference O-E: −9.82% (p<0.01)</div></li></ul></div></li><li id="lt510" class="half_rhythm"><div>Unknown grade (n=244)
|
|
<ul id="l245" class="circle"><li id="lt511" class="half_rhythm"><div>OS ratio O:E: 1.00</div></li><li id="lt512" class="half_rhythm"><div>Difference O-E: 0.26% (ns)</div></li></ul></div></li><li id="lt513" class="half_rhythm"><div><i>Subgroup: tumour size:</i></div></li><li id="lt514" class="half_rhythm"><div>0.1 to 1 cm (n=150)
|
|
<ul id="l246" class="circle"><li id="lt515" class="half_rhythm"><div>OS ratio O:E: 0.93</div></li><li id="lt516" class="half_rhythm"><div>Difference O-E: −6.10% (ns)</div></li></ul></div></li><li id="lt517" class="half_rhythm"><div>1.1 to 2 cm (n=471)
|
|
<ul id="l247" class="circle"><li id="lt518" class="half_rhythm"><div>OS ratio O:E: 0.92</div></li><li id="lt519" class="half_rhythm"><div>Difference O-E: −6.57% (p<0.01)</div></li></ul></div></li><li id="lt520" class="half_rhythm"><div>2.1 to 5 cm (n=444)
|
|
<ul id="l248" class="circle"><li id="lt521" class="half_rhythm"><div>OS ratio O:E: 0.94</div></li><li id="lt522" class="half_rhythm"><div>Difference O-E: −4.26% (ns)</div></li></ul></div></li><li id="lt523" class="half_rhythm"><div><i>Subgroup: nodal status</i></div></li><li id="lt524" class="half_rhythm"><div>Negative (n=733)
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<ul id="l249" class="circle"><li id="lt525" class="half_rhythm"><div>OS ratio O:E = 0.94</div></li><li id="lt526" class="half_rhythm"><div>Difference O-E = −4.70% (p<0.01)</div></li></ul></div></li><li id="lt527" class="half_rhythm"><div>Positive (n=332)
|
|
<ul id="l250" class="circle"><li id="lt528" class="half_rhythm"><div>OS ratio O:E = 0.89</div></li><li id="lt529" class="half_rhythm"><div>Difference O-E = −7.38% (p<0.01)</div></li></ul></div></li><li id="lt530" class="half_rhythm"><div><i>Subgroup: ER status</i></div></li><li id="lt531" class="half_rhythm"><div>Negative (n=261)
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<ul id="l251" class="circle"><li id="lt532" class="half_rhythm"><div>OS ratio O:E = 0.97</div></li><li id="lt533" class="half_rhythm"><div>Difference O-E = −1.93% (ns)</div></li></ul></div></li><li id="lt534" class="half_rhythm"><div>Positive (n=495)
|
|
<ul id="l252" class="circle"><li id="lt535" class="half_rhythm"><div>OS ratio O:E = 0.89</div></li><li id="lt536" class="half_rhythm"><div>Difference O-E = −9.00% (p<0.01)</div></li></ul></div></li><li id="lt537" class="half_rhythm"><div>Unknown (n=309)
|
|
<ul id="l253" class="circle"><li id="lt538" class="half_rhythm"><div>OS ratio O:E = 0.96</div></li><li id="lt539" class="half_rhythm"><div>Difference O-E = −3.04% (ns)</div></li></ul></div></li><li id="lt540" class="half_rhythm"><div>Tool discrimination</div></li><li id="lt541" class="half_rhythm"><div>Not reported</div></li></ul></p>
|
|
</td><td headers="hd_h_chc.tab6_1_1_1_5 hd_b_chc.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l254"><li id="lt542" class="half_rhythm"><div>Unknown confounders</div></li><li id="lt543" class="half_rhythm"><div>OS ratio O:E was calculated by the NGA technical team based on available data on the paper</div></li><li id="lt544" class="half_rhythm"><div>Other factors included in the model: histology, local therapy, systemic therapy</div></li></ul></td><td headers="hd_h_chc.tab6_1_1_1_6 hd_b_chc.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l255"><li id="lt545" class="half_rhythm"><div>High quality, as assessed by CASP Clinical Prediction Rule checklist.</div></li></ul></td></tr><tr><th headers="hd_h_chc.tab6_1_1_1_1 hd_h_chc.tab6_1_1_1_2 hd_h_chc.tab6_1_1_1_3 hd_h_chc.tab6_1_1_1_4 hd_h_chc.tab6_1_1_1_5 hd_h_chc.tab6_1_1_1_6" id="hd_b_chc.tab6_1_1_3_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">10-year breast cancer specific survival (BCSS)</th></tr><tr><td headers="hd_h_chc.tab6_1_1_1_1 hd_b_chc.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#chc.s1.2.ref2" rid="chc.s1.2.ref2">Campbell (2009)</a>
|
|
</td><td headers="hd_h_chc.tab6_1_1_1_2 hd_b_chc.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study</p>
|
|
<p>Study period: 1986 to 1996</p>
|
|
</td><td headers="hd_h_chc.tab6_1_1_1_3 hd_b_chc.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from 1,065 women with early breast cancer diagnosed at the Churchill hospital I Oxford</td><td headers="hd_h_chc.tab6_1_1_1_4 hd_b_chc.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prognostic accuracy (sensitivity, specificity)</p>
|
|
<p>Not reported</p>
|
|
<p>Tool calibration</p>
|
|
<p>All population (N=1058):
|
|
<ul id="l256"><li id="lt546" class="half_rhythm"><div>BCSS ratio O:E: 0.95</div></li><li id="lt547" class="half_rhythm"><div>Difference O-E: −4.53% (p<0.01)</div></li></ul>
|
|
<i>Subgroup: age</i>
|
|
<ul id="l257"><li id="lt548" class="half_rhythm"><div>20 to 35 (n=34)
|
|
<ul id="l258" class="circle"><li id="lt549" class="half_rhythm"><div>BCSS ratio O:E = 0.99</div></li><li id="lt550" class="half_rhythm"><div>Difference O-E = −0.67% (ns)</div></li></ul></div></li><li id="lt551" class="half_rhythm"><div>36 to 50 (n=361)
|
|
<ul id="l259" class="circle"><li id="lt552" class="half_rhythm"><div>BCSS ratio O:E = 0.94</div></li><li id="lt553" class="half_rhythm"><div>Difference O-E = −4.62% (p<0.05)</div></li></ul></div></li><li id="lt554" class="half_rhythm"><div>51 to 65 (n=454)
|
|
<ul id="l260" class="circle"><li id="lt555" class="half_rhythm"><div>BCSS ratio O:E = 0.96</div></li><li id="lt556" class="half_rhythm"><div>Difference O-E = −3.51% (ns)</div></li></ul></div></li><li id="lt557" class="half_rhythm"><div>66 to 75 (n=193)
|
|
<ul id="l261" class="circle"><li id="lt558" class="half_rhythm"><div>BCSS ratio O:E = 0.89</div></li><li id="lt559" class="half_rhythm"><div>Difference O-E = −9.28% (p<0.05)</div></li></ul></div></li><li id="lt560" class="half_rhythm"><div>≥76 (n=16)
|
|
<ul id="l262" class="circle"><li id="lt561" class="half_rhythm"><div>BCSS ratio O:E = 1.08</div></li><li id="lt562" class="half_rhythm"><div>Difference O-E = 7.04% (ns)</div></li></ul></div></li></ul>
|
|
<i>Subgroup: grade:</i>
|
|
<ul id="l263"><li id="lt563" class="half_rhythm"><div>Grade 1 (n=152)
|
|
<ul id="l264" class="circle"><li id="lt564" class="half_rhythm"><div>BCSS ratio O:E: 0.99</div></li><li id="lt565" class="half_rhythm"><div>Difference O-E: −1.29% (ns)</div></li></ul></div></li><li id="lt566" class="half_rhythm"><div>Grade 2 (n=420)
|
|
<ul id="l265" class="circle"><li id="lt567" class="half_rhythm"><div>BCSS ratio O:E: 0.93</div></li><li id="lt568" class="half_rhythm"><div>Difference O-E: −5.89% (p<0.01)</div></li></ul></div></li><li id="lt569" class="half_rhythm"><div>Grade 3 (n=243)
|
|
<ul id="l266" class="circle"><li id="lt570" class="half_rhythm"><div>BCSS ratio O:E: 0.92</div></li><li id="lt571" class="half_rhythm"><div>Difference O-E: −6.10 (p<0.05)</div></li></ul></div></li><li id="lt572" class="half_rhythm"><div>Unknown grade (n=243)
|
|
<ul id="l267" class="circle"><li id="lt573" class="half_rhythm"><div>BCSS ratio O:E: 0.96</div></li><li id="lt574" class="half_rhythm"><div>Difference O-E: −2.78 (ns)</div></li></ul></div></li><li id="lt575" class="half_rhythm"><div><i>Subgroup: tumour size:</i></div></li><li id="lt576" class="half_rhythm"><div>0.1 to 1 cm (n=148)
|
|
<ul id="l268" class="circle"><li id="lt577" class="half_rhythm"><div>BCSS ratio O:E: 0.92</div></li><li id="lt578" class="half_rhythm"><div>Difference O-E: −7.95% (p<0.01)</div></li></ul></div></li><li id="lt579" class="half_rhythm"><div>1.1 to 2 cm (n=470)
|
|
<ul id="l269" class="circle"><li id="lt580" class="half_rhythm"><div>BCSS ratio O:E: 0.95</div></li><li id="lt581" class="half_rhythm"><div>Difference O-E: −4.54% (p<0.01)</div></li></ul></div></li><li id="lt582" class="half_rhythm"><div>2.1 to 5 cm (n=440)
|
|
<ul id="l270" class="circle"><li id="lt583" class="half_rhythm"><div>BCSS ratio O:E: 0.95</div></li><li id="lt584" class="half_rhythm"><div>Difference O-E: −3.53% (ns</div></li></ul></div></li><li id="lt585" class="half_rhythm"><div><i>Subgroup: nodal status</i></div></li><li id="lt586" class="half_rhythm"><div>Negative (n=729)
|
|
<ul id="l271" class="circle"><li id="lt587" class="half_rhythm"><div>BCSS ratio O:E = 0.96</div></li><li id="lt588" class="half_rhythm"><div>Difference O-E = −3.53% (p<0.01)</div></li></ul></div></li><li id="lt589" class="half_rhythm"><div>Positive (n=329)
|
|
<ul id="l272" class="circle"><li id="lt590" class="half_rhythm"><div>BCSS ratio O:E = 0.91</div></li><li id="lt591" class="half_rhythm"><div>Difference O-E = −6.73% (p<0.01)</div></li></ul></div></li><li id="lt592" class="half_rhythm"><div><i>Subgroup: ER status</i></div></li><li id="lt593" class="half_rhythm"><div>Negative (n=259)
|
|
<ul id="l273" class="circle"><li id="lt594" class="half_rhythm"><div>BCSS ratio O:E = 0.96</div></li><li id="lt595" class="half_rhythm"><div>Difference O-E = −2.76% (ns</div></li></ul></div></li><li id="lt596" class="half_rhythm"><div>Positive (n=491)
|
|
<ul id="l274" class="circle"><li id="lt597" class="half_rhythm"><div>BCSS ratio O:E = 0.92</div></li><li id="lt598" class="half_rhythm"><div>Difference O-E = −6.62% (p<0.01)</div></li></ul></div></li><li id="lt599" class="half_rhythm"><div>Unknown (n=308)
|
|
<ul id="l275" class="circle"><li id="lt600" class="half_rhythm"><div>BCSS ratio O:E = 0.96</div></li><li id="lt601" class="half_rhythm"><div>Difference O-E = −2.74% (ns</div></li></ul></div></li><li id="lt602" class="half_rhythm"><div>Tool discrimination</div></li><li id="lt603" class="half_rhythm"><div>Not reported</div></li></ul></p>
|
|
</td><td headers="hd_h_chc.tab6_1_1_1_5 hd_b_chc.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l276"><li id="lt604" class="half_rhythm"><div>Unknown confounders</div></li><li id="lt605" class="half_rhythm"><div>BCSS ratio O:E was calculated by the NGA technical team based on available data on the paper</div></li><li id="lt606" class="half_rhythm"><div>Other factors included in the model: histology, local therapy, systemic therapy</div></li></ul></td><td headers="hd_h_chc.tab6_1_1_1_6 hd_b_chc.tab6_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l277"><li id="lt607" class="half_rhythm"><div>High quality, as assessed by CASP Clinical Prediction Rule checklist.</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">BCSS, breast cancer specific survival; CASP, Critical Appraisal Skills Programme; ER, oestrogen receptor; NGA, National Guideline Alliance; ns, not significant; O-E, observed minus expected; O:E, observed/ expected; OS, overall survival; UK, United Kingdom</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchctab7"><div id="chc.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Summary of included studies and results for PREDICT</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_chc.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study details</th><th id="hd_h_chc.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_chc.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Findings</th><th id="hd_h_chc.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th><th id="hd_h_chc.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_chc.tab7_1_1_1_1 hd_h_chc.tab7_1_1_1_2 hd_h_chc.tab7_1_1_1_3 hd_h_chc.tab7_1_1_1_4 hd_h_chc.tab7_1_1_1_5 hd_h_chc.tab7_1_1_1_6" id="hd_b_chc.tab7_1_1_1_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">5-year all-cause mortality [PREDICT v1.0]</th></tr><tr><td headers="hd_h_chc.tab7_1_1_1_1 hd_b_chc.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref9" rid="chc.s1.2.ref9">Wishart (2010)</a>
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|
</td><td headers="hd_h_chc.tab7_1_1_1_2 hd_b_chc.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study</p>
|
|
<p>Study period: 1999 to 2003</p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_3 hd_b_chc.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from 5468 people with breast cancer from the West Midlands Cancer Intelligence Unit (WMCIU)</td><td headers="hd_h_chc.tab7_1_1_1_4 hd_b_chc.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l278"><li id="lt608" class="half_rhythm"><div>Prognostic accuracy (sensitivity, specificity)</div></li><li id="lt609" class="half_rhythm"><div>Not reported</div></li><li id="lt610" class="half_rhythm"><div>Tool calibration</div></li><li id="lt611" class="half_rhythm"><div>Total cohort (N=5468)</div></li><li id="lt612" class="half_rhythm"><div>Mortality ratio O:E = 0.91</div></li><li id="lt613" class="half_rhythm"><div>Difference O-E = −1.61%</div></li><li id="lt614" class="half_rhythm"><div><i>Subgroup: age</i></div></li><li id="lt615" class="half_rhythm"><div><35 (n=108)
|
|
<ul id="l279" class="circle"><li id="lt616" class="half_rhythm"><div>Mortality ratio O:E = 0.88</div></li><li id="lt617" class="half_rhythm"><div>Difference O-E = −2.78%</div></li></ul></div></li><li id="lt618" class="half_rhythm"><div>35 to 49 (n=1195)
|
|
<ul id="l280" class="circle"><li id="lt619" class="half_rhythm"><div>Mortality ratio O:E = 0.83</div></li><li id="lt620" class="half_rhythm"><div>Difference O-E = −2.68%</div></li></ul></div></li><li id="lt621" class="half_rhythm"><div>50 to 67 (n=2393)
|
|
<ul id="l281" class="circle"><li id="lt622" class="half_rhythm"><div>Mortality ratio O:E = 0.90</div></li><li id="lt623" class="half_rhythm"><div>Difference O-E = −1.34%</div></li></ul></div></li><li id="lt624" class="half_rhythm"><div>65 to 74 (n=1101)
|
|
<ul id="l282" class="circle"><li id="lt625" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt626" class="half_rhythm"><div>Difference O-E = −0.45%</div></li></ul></div></li><li id="lt627" class="half_rhythm"><div>75+ (n=671)
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|
<ul id="l283" class="circle"><li id="lt628" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt629" class="half_rhythm"><div>Difference O-E = −0.75%</div></li></ul></div></li><li id="lt630" class="half_rhythm"><div><i>Subgroup: grade</i></div></li><li id="lt631" class="half_rhythm"><div>Grade 1 (n=1017)
|
|
<ul id="l284" class="circle"><li id="lt632" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt633" class="half_rhythm"><div>Difference O-E = −0.1%</div></li></ul></div></li><li id="lt634" class="half_rhythm"><div>Grade 2 (n=2442)
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|
<ul id="l285" class="circle"><li id="lt635" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt636" class="half_rhythm"><div>Difference O-E = −0.16%</div></li></ul></div></li><li id="lt637" class="half_rhythm"><div>Grade 3 (n=2009)
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|
<ul id="l286" class="circle"><li id="lt638" class="half_rhythm"><div>Mortality ratio O:E = 0.87</div></li><li id="lt639" class="half_rhythm"><div>Difference O-E = −3.58%</div></li></ul></div></li><li id="lt640" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt641" class="half_rhythm"><div><10 mm (n=485)
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|
<ul id="l287" class="circle"><li id="lt642" class="half_rhythm"><div>Mortality ratio O:E = 0.84</div></li><li id="lt643" class="half_rhythm"><div>Difference O-E = −1.03%</div></li></ul></div></li><li id="lt644" class="half_rhythm"><div>10 to 19 mm (n=2136)
|
|
<ul id="l288" class="circle"><li id="lt645" class="half_rhythm"><div>Mortality ratio O:E = 0.88</div></li><li id="lt646" class="half_rhythm"><div>Difference O-E = −2.01%</div></li></ul></div></li><li id="lt647" class="half_rhythm"><div>20 to 29 mm (n=1566)
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|
<ul id="l289" class="circle"><li id="lt648" class="half_rhythm"><div>Mortality ratio O:E = 0.94</div></li><li id="lt649" class="half_rhythm"><div>Difference O-E = −0.96%</div></li></ul></div></li><li id="lt650" class="half_rhythm"><div>30 to 49 mm (n=923)
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|
<ul id="l290" class="circle"><li id="lt651" class="half_rhythm"><div>Mortality ratio O:E = 0.99</div></li><li id="lt652" class="half_rhythm"><div>Difference O-E = −0.11%</div></li></ul></div></li><li id="lt653" class="half_rhythm"><div>50+ mm (n=358)
|
|
<ul id="l291" class="circle"><li id="lt654" class="half_rhythm"><div>Mortality ratio O:E = 0.91</div></li><li id="lt655" class="half_rhythm"><div>Difference O-E = −3.91%</div></li></ul></div></li><li id="lt656" class="half_rhythm"><div><i>Subgroup: nodal status</i></div></li><li id="lt657" class="half_rhythm"><div>Negative (n=3184)
|
|
<ul id="l292" class="circle"><li id="lt658" class="half_rhythm"><div>Mortality ratio O:E = 0.80</div></li><li id="lt659" class="half_rhythm"><div>Difference O-E = −2.14%</div></li></ul></div></li><li id="lt660" class="half_rhythm"><div>Positive (n=2284)
|
|
<ul id="l293" class="circle"><li id="lt661" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt662" class="half_rhythm"><div>Difference O-E = −0.39%</div></li></ul></div></li><li id="lt663" class="half_rhythm"><div><i>Subgroup: ER status</i></div></li><li id="lt664" class="half_rhythm"><div>Negative (n=1116)
|
|
<ul id="l294" class="circle"><li id="lt665" class="half_rhythm"><div>Mortality ratio O:E = 0.87</div></li><li id="lt666" class="half_rhythm"><div>Difference O-E = −4.21%</div></li></ul></div></li><li id="lt667" class="half_rhythm"><div>Positive (n=4352)
|
|
<ul id="l295" class="circle"><li id="lt668" class="half_rhythm"><div>Mortality ratio O:E = 0.95</div></li><li id="lt669" class="half_rhythm"><div>Difference O-E = −0.69%</div></li></ul></div></li><li id="lt670" class="half_rhythm"><div><b>Tool discrimination</b></div></li><li id="lt671" class="half_rhythm"><div>ER+: AUC=0.81; SE=0.0111</div></li><li id="lt672" class="half_rhythm"><div>ER-: AUC=0.75; SE=0.0169</div></li></ul>
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|
</td><td headers="hd_h_chc.tab7_1_1_1_5 hd_b_chc.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul id="l296"><li id="lt673" class="half_rhythm"><div>PREDICT v1.0</div></li><li id="lt674" class="half_rhythm"><div>Validation study (data from the primary analysis has not been reported)</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_6 hd_b_chc.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate quality, as assessed by CASP Clinical Prediction Rule checklist</td></tr><tr><th headers="hd_h_chc.tab7_1_1_1_1 hd_h_chc.tab7_1_1_1_2 hd_h_chc.tab7_1_1_1_3 hd_h_chc.tab7_1_1_1_4 hd_h_chc.tab7_1_1_1_5 hd_h_chc.tab7_1_1_1_6" id="hd_b_chc.tab7_1_1_3_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">5-year all-cause mortality [PREDICT v1.2]</th></tr><tr><td headers="hd_h_chc.tab7_1_1_1_1 hd_b_chc.tab7_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref6" rid="chc.s1.2.ref6">Maishman (2015)</a>
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|
</td><td headers="hd_h_chc.tab7_1_1_1_2 hd_b_chc.tab7_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study</p>
|
|
<p>Study period: 2000 to 2008</p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_3 hd_b_chc.tab7_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from 3000 women aged ≤40 years at diagnosis (POSH cohort)</td><td headers="hd_h_chc.tab7_1_1_1_4 hd_b_chc.tab7_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l297"><li id="lt675" class="half_rhythm"><div><b>Prognostic accuracy (sensitivity, specificity)</b></div></li><li id="lt676" class="half_rhythm"><div>Not reported</div></li><li id="lt677" class="half_rhythm"><div><b>Tool calibration</b></div></li><li id="lt678" class="half_rhythm"><div>Total cohort (N=2827)</div></li><li id="lt679" class="half_rhythm"><div>Mortality ratio O:E = 1.33</div></li><li id="lt680" class="half_rhythm"><div>Difference O-E = 25% (n=152)</div></li><li id="lt681" class="half_rhythm"><div><i>Subgroup: age at diagnosis</i></div></li><li id="lt682" class="half_rhythm"><div>18 to 25 (n=40)
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|
<ul id="l298" class="circle"><li id="lt683" class="half_rhythm"><div>Mortality ratio O:E = 1.4</div></li><li id="lt684" class="half_rhythm"><div>Difference O-E = 28.6% (n=2)</div></li></ul></div></li><li id="lt685" class="half_rhythm"><div>26 to 30 (n=258)
|
|
<ul id="l299" class="circle"><li id="lt686" class="half_rhythm"><div>Mortality ratio O:E = 1.35</div></li><li id="lt687" class="half_rhythm"><div>Difference O-E = 25.8% (n=16)</div></li></ul></div></li><li id="lt688" class="half_rhythm"><div>31 to 35 (n=864)
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|
<ul id="l300" class="circle"><li id="lt689" class="half_rhythm"><div>Mortality ratio O:E = 1.38</div></li><li id="lt690" class="half_rhythm"><div>Difference O-E = 27.6% (n=58)</div></li></ul></div></li><li id="lt691" class="half_rhythm"><div>36 to 40 (n=1665)
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|
<ul id="l301" class="circle"><li id="lt692" class="half_rhythm"><div>Mortality ratio O:E = 1.30</div></li><li id="lt693" class="half_rhythm"><div>Difference O-E = 23.2% (n=76)</div></li></ul></div></li><li id="lt694" class="half_rhythm"><div><i>Subgroup: grade</i></div></li><li id="lt695" class="half_rhythm"><div>Grade 1 (n=156)
|
|
<ul id="l302" class="circle"><li id="lt696" class="half_rhythm"><div>Mortality ratio O:E = 1.25</div></li><li id="lt697" class="half_rhythm"><div>Difference O-E = 20% (n=1)</div></li></ul></div></li><li id="lt698" class="half_rhythm"><div>Grade 2 (n=929)
|
|
<ul id="l303" class="circle"><li id="lt699" class="half_rhythm"><div>Mortality ratio O:E = 2.40</div></li><li id="lt700" class="half_rhythm"><div>Difference O-E = 58.4% (n=94)</div></li></ul></div></li><li id="lt701" class="half_rhythm"><div>Grade 3 (n=1676)
|
|
<ul id="l304" class="circle"><li id="lt702" class="half_rhythm"><div>Mortality ratio O:E = 1.13</div></li><li id="lt703" class="half_rhythm"><div>Difference O-E = 11.9% (n=51)</div></li></ul></div></li><li id="lt704" class="half_rhythm"><div>Unknown (n=66)
|
|
<ul id="l305" class="circle"><li id="lt705" class="half_rhythm"><div>Mortality ratio O:E = 1.71</div></li><li id="lt706" class="half_rhythm"><div>Difference O-E = 41.7% (n=5)</div></li></ul></div></li><li id="lt707" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt708" class="half_rhythm"><div>0 to 10 mm (n=265)
|
|
<ul id="l306" class="circle"><li id="lt709" class="half_rhythm"><div>Mortality ratio O:E = 2.1</div></li><li id="lt710" class="half_rhythm"><div>Difference O-E = 52.4% (n=22)</div></li></ul></div></li><li id="lt711" class="half_rhythm"><div>11 to 20 mm (n=930)
|
|
<ul id="l307" class="circle"><li id="lt712" class="half_rhythm"><div>Mortality ratio O:E = 1.25</div></li><li id="lt713" class="half_rhythm"><div>Difference O-E = 20% (n=25)</div></li></ul></div></li><li id="lt714" class="half_rhythm"><div>21 to 50 mm (n=1229)
|
|
<ul id="l308" class="circle"><li id="lt715" class="half_rhythm"><div>Mortality ratio O:E = 1.26</div></li><li id="lt716" class="half_rhythm"><div>Difference O-E = 22.8% (n=69)</div></li></ul></div></li><li id="lt717" class="half_rhythm"><div>>50 mm (n=244)
|
|
<ul id="l309" class="circle"><li id="lt718" class="half_rhythm"><div>Mortality ratio O:E = 1.16</div></li><li id="lt719" class="half_rhythm"><div>Difference O-E = 14% (n=85)</div></li></ul></div></li><li id="lt720" class="half_rhythm"><div>Unknown (n=159)
|
|
<ul id="l310" class="circle"><li id="lt721" class="half_rhythm"><div>Mortality ratio O:E = 2.44</div></li><li id="lt722" class="half_rhythm"><div>Difference O-E = 59% (n=23)</div></li></ul></div></li><li id="lt723" class="half_rhythm"><div><i>Subgroup: node status</i></div></li><li id="lt724" class="half_rhythm"><div>Negative (n=1370)
|
|
<ul id="l311" class="circle"><li id="lt725" class="half_rhythm"><div>Mortality ratio O:E = 1.26</div></li><li id="lt726" class="half_rhythm"><div>Difference O-E = 20.5% (n=33)</div></li></ul></div></li><li id="lt727" class="half_rhythm"><div>Positive (n=1431)
|
|
<ul id="l312" class="circle"><li id="lt728" class="half_rhythm"><div>Mortality ratio O:E = 1.35</div></li><li id="lt729" class="half_rhythm"><div>Difference O-E = 26.2% (n=115)</div></li></ul></div></li><li id="lt730" class="half_rhythm"><div>Unknown (n=26)
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|
<ul id="l313" class="circle"><li id="lt731" class="half_rhythm"><div>Mortality ratio O:E = 1.75</div></li><li id="lt732" class="half_rhythm"><div>Difference O-E = 42.9% (n=3)</div></li></ul></div></li><li id="lt733" class="half_rhythm"><div><i>Subgroup: ER status</i></div></li><li id="lt734" class="half_rhythm"><div>Negative (n=965)
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|
<ul id="l314" class="circle"><li id="lt735" class="half_rhythm"><div>Mortality ratio O:E = 0.82</div></li><li id="lt736" class="half_rhythm"><div>Difference O-E = −21.2% (n=-52)</div></li></ul></div></li><li id="lt737" class="half_rhythm"><div>Positive (n=1862)
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|
<ul id="l315" class="circle"><li id="lt738" class="half_rhythm"><div>Mortality ratio O:E = 2.29</div></li><li id="lt739" class="half_rhythm"><div>Difference O-E = 56.4% (n=204)</div></li></ul></div></li><li id="lt740" class="half_rhythm"><div><i>Subgroup: HER2 status</i></div></li><li id="lt741" class="half_rhythm"><div>Negative (n=1773)
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|
<ul id="l316" class="circle"><li id="lt742" class="half_rhythm"><div>Mortality ratio O:E = 1.50</div></li><li id="lt743" class="half_rhythm"><div>Difference O-E = 33.4% (n=128)</div></li></ul></div></li><li id="lt744" class="half_rhythm"><div>Positive (n=679)
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|
<ul id="l317" class="circle"><li id="lt745" class="half_rhythm"><div>Mortality ratio O:E = 1.15</div></li><li id="lt746" class="half_rhythm"><div>Difference O-E = 13.1% (n=24)</div></li></ul></div></li><li id="lt747" class="half_rhythm"><div>Borderline (n=40)
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|
<ul id="l318" class="circle"><li id="lt748" class="half_rhythm"><div>Mortality ratio O:E = 1.67</div></li><li id="lt749" class="half_rhythm"><div>Difference O-E = 40% (n=4)</div></li></ul></div></li><li id="lt750" class="half_rhythm"><div>Unknown (n=335)
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|
<ul id="l319" class="circle"><li id="lt751" class="half_rhythm"><div>Mortality ratio O:E = 0.88</div></li><li id="lt752" class="half_rhythm"><div>Difference O-E = −12.9% (n=-4)</div></li></ul></div></li><li id="lt753" class="half_rhythm"><div><b>Tool discrimination</b></div></li><li id="lt754" class="half_rhythm"><div>AUC ER- vs ER+ = 0.718 vs 0.730</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_5 hd_b_chc.tab7_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<ul id="l320"><li id="lt755" class="half_rhythm"><div>PREDICT v1.2</div></li><li id="lt756" class="half_rhythm"><div>Other factors in the tool: menopausal status, morphology, LV invasion, ER status, local treatment, systemic treatment, HER2 status, ethnicity</div></li><li id="lt757" class="half_rhythm"><div>Other outcomes reported: 8-year all-cause mortality</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_6 hd_b_chc.tab7_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l321"><li id="lt758" class="half_rhythm"><div>High quality, as assessed by CASP Clinical Prediction Rule checklist</div></li></ul></td></tr><tr><th headers="hd_h_chc.tab7_1_1_1_1 hd_h_chc.tab7_1_1_1_2 hd_h_chc.tab7_1_1_1_3 hd_h_chc.tab7_1_1_1_4 hd_h_chc.tab7_1_1_1_5 hd_h_chc.tab7_1_1_1_6" id="hd_b_chc.tab7_1_1_5_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">8-year all-cause mortality [PREDICT 1.0] (proxy for long-term OS)</th></tr><tr><td headers="hd_h_chc.tab7_1_1_1_1 hd_b_chc.tab7_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<a class="bibr" href="#chc.s1.2.ref9" rid="chc.s1.2.ref9">Wishart (2010)</a>
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|
</td><td headers="hd_h_chc.tab7_1_1_1_2 hd_b_chc.tab7_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study</p>
|
|
<p>Study period: 1999 to 2003</p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_3 hd_b_chc.tab7_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from 5468 people with breast cancer from the West Midlands Cancer Intelligence Unit (WMCIU)</td><td headers="hd_h_chc.tab7_1_1_1_4 hd_b_chc.tab7_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<ul id="l322"><li id="lt759" class="half_rhythm"><div><b>Prognostic accuracy (sensitivity, specificity)</b></div></li><li id="lt760" class="half_rhythm"><div>Not reported</div></li><li id="lt761" class="half_rhythm"><div><b>Tool calibration and discrimination</b></div></li><li id="lt762" class="half_rhythm"><div>Total cohort (N=5468):</div></li><li id="lt763" class="half_rhythm"><div>Mortality ratio O:E = 0.95</div></li><li id="lt764" class="half_rhythm"><div>Difference O-E = −0.93%</div></li><li id="lt765" class="half_rhythm"><div><i>Subgroup: age</i></div></li><li id="lt766" class="half_rhythm"><div><35 (n=108)
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|
<ul id="l323" class="circle"><li id="lt767" class="half_rhythm"><div>Mortality ratio O:E = 1.08</div></li><li id="lt768" class="half_rhythm"><div>Difference O-E = 1.85%</div></li></ul></div></li><li id="lt769" class="half_rhythm"><div>35 to 49 (n=1195)
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|
<ul id="l324" class="circle"><li id="lt770" class="half_rhythm"><div>Mortality ratio O:E = 0.87</div></li><li id="lt771" class="half_rhythm"><div>Difference O-E = −2.18%</div></li></ul></div></li><li id="lt772" class="half_rhythm"><div>50 to 67 (n=2393)
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|
<ul id="l325" class="circle"><li id="lt773" class="half_rhythm"><div>Mortality ratio O:E = 0.92</div></li><li id="lt774" class="half_rhythm"><div>Difference O-E = −1%</div></li></ul></div></li><li id="lt775" class="half_rhythm"><div>65 to 74 (n=1101)
|
|
<ul id="l326" class="circle"><li id="lt776" class="half_rhythm"><div>Mortality ratio O:E = 1.00</div></li><li id="lt777" class="half_rhythm"><div>Difference O-E = −0.09%</div></li></ul></div></li><li id="lt778" class="half_rhythm"><div>75+ (n=671)
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|
<ul id="l327" class="circle"><li id="lt779" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt780" class="half_rhythm"><div>Difference O-E = −0.6%</div></li></ul></div></li><li id="lt781" class="half_rhythm"><div><i>Subgroup: grade</i></div></li><li id="lt782" class="half_rhythm"><div>Grade 1 (n=1017)
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|
<ul id="l328" class="circle"><li id="lt783" class="half_rhythm"><div>Mortality ratio O:E = 1.04</div></li><li id="lt784" class="half_rhythm"><div>Difference O-E = 0.29%</div></li></ul></div></li><li id="lt785" class="half_rhythm"><div>Grade 2 (n=2442)
|
|
<ul id="l329" class="circle"><li id="lt786" class="half_rhythm"><div>Mortality ratio O:E = 1.04</div></li><li id="lt787" class="half_rhythm"><div>Difference O-E = 0.61%</div></li></ul></div></li><li id="lt788" class="half_rhythm"><div>Grade 3 (n=2009)
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|
<ul id="l330" class="circle"><li id="lt789" class="half_rhythm"><div>Mortality ratio O:E = 0.88</div></li><li id="lt790" class="half_rhythm"><div>Difference O-E = −3.38%</div></li></ul></div></li><li id="lt791" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt792" class="half_rhythm"><div><10 mm (n=485)
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|
<ul id="l331" class="circle"><li id="lt793" class="half_rhythm"><div>Mortality ratio O:E = 0.85</div></li><li id="lt794" class="half_rhythm"><div>Difference O-E = −1.03%</div></li></ul></div></li><li id="lt795" class="half_rhythm"><div>10 to 19 mm (n=2136)
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|
<ul id="l332" class="circle"><li id="lt796" class="half_rhythm"><div>Mortality ratio O:E = 0.84</div></li><li id="lt797" class="half_rhythm"><div>Difference O-E = −1.73%</div></li></ul></div></li><li id="lt798" class="half_rhythm"><div>20 to 29 mm (n=1566)
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|
<ul id="l333" class="circle"><li id="lt799" class="half_rhythm"><div>Mortality ratio O:E = 0.97</div></li><li id="lt800" class="half_rhythm"><div>Difference O-E = −0.57%</div></li></ul></div></li><li id="lt801" class="half_rhythm"><div>30 to 49 mm (n=923)
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|
<ul id="l334" class="circle"><li id="lt802" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt803" class="half_rhythm"><div>Difference O-E = −0.43%</div></li></ul></div></li><li id="lt804" class="half_rhythm"><div>50+ mm (n=358)
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|
<ul id="l335" class="circle"><li id="lt805" class="half_rhythm"><div>Mortality ratio O:E = 0.56</div></li><li id="lt806" class="half_rhythm"><div>Difference O-E = −3.35%</div></li></ul></div></li><li id="lt807" class="half_rhythm"><div><i>Subgroup: nodal status</i></div></li><li id="lt808" class="half_rhythm"><div>Negative (n=3184)
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|
<ul id="l336" class="circle"><li id="lt809" class="half_rhythm"><div>Mortality ratio O:E = 0.84</div></li><li id="lt810" class="half_rhythm"><div>Difference O-E = −1.76%</div></li></ul></div></li><li id="lt811" class="half_rhythm"><div>Positive (n=2284)
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<ul id="l337" class="circle"><li id="lt812" class="half_rhythm"><div>Mortality ratio O:E = 1.01</div></li><li id="lt813" class="half_rhythm"><div>Difference O-E = 0.26%</div></li></ul></div></li><li id="lt814" class="half_rhythm"><div><i>Subgroup: ER status</i></div></li><li id="lt815" class="half_rhythm"><div>Negative (n=1116)
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<ul id="l338" class="circle"><li id="lt816" class="half_rhythm"><div>Mortality ratio O:E = 0.90</div></li><li id="lt817" class="half_rhythm"><div>Difference O-E = −3.49%</div></li></ul></div></li><li id="lt818" class="half_rhythm"><div>Positive (n=4352)
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<ul id="l339" class="circle"><li id="lt819" class="half_rhythm"><div>Mortality ratio O:E = 0.98</div></li><li id="lt820" class="half_rhythm"><div>Difference O-E = −0.25%</div></li></ul></div></li><li id="lt821" class="half_rhythm"><div><b>Tool discrimination (AUC)</b></div></li><li id="lt822" class="half_rhythm"><div>Total cohort (N=5468): AUC (SE) = 0.79 (0.008)</div></li><li id="lt823" class="half_rhythm"><div><i>Subgroup: age</i></div></li><li id="lt824" class="half_rhythm"><div><35 (n=108); AUC (SE) = 0.70 (0.057)</div></li><li id="lt825" class="half_rhythm"><div>35 to 49 (n=1195); AUC (SE) = 0.79 (0.018)</div></li><li id="lt826" class="half_rhythm"><div>50 to 67 (n=2393); AUC (SE) = 0.80 (0.013)</div></li><li id="lt827" class="half_rhythm"><div>65 to 74 (n=1101); AUC (SE) =0.76 (0.018)</div></li><li id="lt828" class="half_rhythm"><div>75+ (n=671); AUC (SE) = 0.72 (0.021)</div></li><li id="lt829" class="half_rhythm"><div><i>Subgroup: grade</i></div></li><li id="lt830" class="half_rhythm"><div>Grade 1 (n=1017): AUC (SE) = 0.79 (0.029)</div></li><li id="lt831" class="half_rhythm"><div>Grade 2 (n=2442): AUC (SE) = 0.77 (0.013)</div></li><li id="lt832" class="half_rhythm"><div>Grade 3 (n=2009): AUC (SE) = 0.75 (0.012)</div></li><li id="lt833" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt834" class="half_rhythm"><div><10 mm (n=485): AUC (SE) = 0.82 (0.040)</div></li><li id="lt835" class="half_rhythm"><div>10 to 19 mm (n=2136): AUC (SE) = 0.76 (0.018)</div></li><li id="lt836" class="half_rhythm"><div>20 to 29 mm (n=1566): AUC (SE) = 0.71 (0.017)</div></li><li id="lt837" class="half_rhythm"><div>30 to 49 mm (n=923): AUC (SE) = 0.72 (0.018)</div></li><li id="lt838" class="half_rhythm"><div>50+ mm (n=358): AUC (SE) = 0.72 (0.027)</div></li><li id="lt839" class="half_rhythm"><div><i>Subgroup: nodal status</i></div></li><li id="lt840" class="half_rhythm"><div>Negative (n=3184): AUC (SE) = 0.74 (0.015)</div></li><li id="lt841" class="half_rhythm"><div>Positive (n=2284): AUC (SE) = 0.75 (0.011)</div></li><li id="lt842" class="half_rhythm"><div><i>Subgroup: ER status</i></div></li><li id="lt843" class="half_rhythm"><div>Negative (n=1116): AUC (SE) = 0.76 (0.016)</div></li><li id="lt844" class="half_rhythm"><div>Positive (n=4352): AUC (SE) = 0.78 (0.010)</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_5 hd_b_chc.tab7_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l340"><li id="lt845" class="half_rhythm"><div>PREDICT v1.0</div></li><li id="lt846" class="half_rhythm"><div>Validation study (data from the primary analysis has not been reported)</div></li><li id="lt847" class="half_rhythm"><div>10-year all-cause mortality was not reported in the paper. 8-year all-cause mortality was taken as a proxy outcome instead</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_6 hd_b_chc.tab7_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l341"><li id="lt848" class="half_rhythm"><div>Moderate quality, as assessed by CASP Clinical Prediction Rule checklist.</div></li></ul></td></tr><tr><th headers="hd_h_chc.tab7_1_1_1_1 hd_h_chc.tab7_1_1_1_2 hd_h_chc.tab7_1_1_1_3 hd_h_chc.tab7_1_1_1_4 hd_h_chc.tab7_1_1_1_5 hd_h_chc.tab7_1_1_1_6" id="hd_b_chc.tab7_1_1_7_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">10-year all-cause mortality [PREDICT v1.2]</th></tr><tr><td headers="hd_h_chc.tab7_1_1_1_1 hd_b_chc.tab7_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref6" rid="chc.s1.2.ref6">Maishman (2015)</a>
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|
</td><td headers="hd_h_chc.tab7_1_1_1_2 hd_b_chc.tab7_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Validation study</p>
|
|
<p>Study period: 2000 to 2008</p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_3 hd_b_chc.tab7_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data from 3000 women aged ≤40 years at diagnosis (POSH cohort)</td><td headers="hd_h_chc.tab7_1_1_1_4 hd_b_chc.tab7_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l342"><li id="lt849" class="half_rhythm"><div><b>Prognostic accuracy (sensitivity, specificity)</b></div></li><li id="lt850" class="half_rhythm"><div>Not reported</div></li><li id="lt851" class="half_rhythm"><div><b>Tool calibration</b></div></li><li id="lt852" class="half_rhythm"><div>Total cohort (N=597)</div></li><li id="lt853" class="half_rhythm"><div>Mortality ratio O:E = 0.93</div></li><li id="lt854" class="half_rhythm"><div>Difference O-E = −7.9% (n=-12)</div></li><li id="lt855" class="half_rhythm"><div><i>Subgroup: age at diagnosis</i></div></li><li id="lt856" class="half_rhythm"><div>18 to 25 (n=8)
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<ul id="l343" class="circle"><li id="lt857" class="half_rhythm"><div>Mortality ratio O:E = 1</div></li><li id="lt858" class="half_rhythm"><div>Difference O-E = 0% (n=0)</div></li></ul></div></li><li id="lt859" class="half_rhythm"><div>26 to 30 (n=55)
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<ul id="l344" class="circle"><li id="lt860" class="half_rhythm"><div>Mortality ratio O:E = 0.94</div></li><li id="lt861" class="half_rhythm"><div>Difference O-E = −6.7% (n=-1)</div></li></ul></div></li><li id="lt862" class="half_rhythm"><div>31 to 35 (n=203)
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<ul id="l345" class="circle"><li id="lt863" class="half_rhythm"><div>Mortality ratio O:E = 1.05</div></li><li id="lt864" class="half_rhythm"><div>Difference O-E = 5% (n=3)</div></li></ul></div></li><li id="lt865" class="half_rhythm"><div>36 to 40 (n=331)
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<ul id="l346" class="circle"><li id="lt866" class="half_rhythm"><div>Mortality ratio O:E = 0.84</div></li><li id="lt867" class="half_rhythm"><div>Difference O-E = −18.4% (n=-14)</div></li></ul></div></li><li id="lt868" class="half_rhythm"><div><i>Subgroup: grade</i></div></li><li id="lt869" class="half_rhythm"><div>Grade 1 (n=31)
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<ul id="l347" class="circle"><li id="lt870" class="half_rhythm"><div>Mortality ratio O:E = 1.5</div></li><li id="lt871" class="half_rhythm"><div>Difference O-E = 33% (n=1)</div></li></ul></div></li><li id="lt872" class="half_rhythm"><div>Grade 2 (n=200)
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<ul id="l348" class="circle"><li id="lt873" class="half_rhythm"><div>Mortality ratio O:E = 1.42</div></li><li id="lt874" class="half_rhythm"><div>Difference O-E = 30% (n=13)</div></li></ul></div></li><li id="lt875" class="half_rhythm"><div>Grade 3 (n=351)
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<ul id="l349" class="circle"><li id="lt876" class="half_rhythm"><div>Mortality ratio O:E = 0.80</div></li><li id="lt877" class="half_rhythm"><div>Difference O-E = −25.5% (n=26)</div></li></ul></div></li><li id="lt878" class="half_rhythm"><div>Unknown (n=15)
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<ul id="l350" class="circle"><li id="lt879" class="half_rhythm"><div>Mortality ratio O:E = 1</div></li><li id="lt880" class="half_rhythm"><div>Difference O-E = 0% (n=0)</div></li></ul></div></li><li id="lt881" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt882" class="half_rhythm"><div>0 to 10 (n=48)
|
|
<ul id="l351" class="circle"><li id="lt883" class="half_rhythm"><div>Mortality ratio O:E = 2</div></li><li id="lt884" class="half_rhythm"><div>Difference O-E = 50% (n=7)</div></li></ul></div></li><li id="lt885" class="half_rhythm"><div>11 to 20 (n=221)
|
|
<ul id="l352" class="circle"><li id="lt886" class="half_rhythm"><div>Mortality ratio O:E = 0.91</div></li><li id="lt887" class="half_rhythm"><div>Difference O-E = −9.8% (n=-4)</div></li></ul></div></li><li id="lt888" class="half_rhythm"><div>21 to 50 (n=244)
|
|
<ul id="l353" class="circle"><li id="lt889" class="half_rhythm"><div>Mortality ratio O:E = 0.99</div></li><li id="lt890" class="half_rhythm"><div>Difference O-E = −1.3% (n=-1)</div></li></ul></div></li><li id="lt891" class="half_rhythm"><div>>50 (n=54)
|
|
<ul id="l354" class="circle"><li id="lt892" class="half_rhythm"><div>Mortality ratio O:E = 0.46</div></li><li id="lt893" class="half_rhythm"><div>Difference O-E = −115.4% (n=-15)</div></li></ul></div></li><li id="lt894" class="half_rhythm"><div>Unknown (n=30)
|
|
<ul id="l355" class="circle"><li id="lt895" class="half_rhythm"><div>Mortality ratio O:E = 1.2</div></li><li id="lt896" class="half_rhythm"><div>Difference O-E = 16.7% (n=1)</div></li></ul></div></li><li id="lt897" class="half_rhythm"><div><i>Subgroup: node status</i></div></li><li id="lt898" class="half_rhythm"><div>Negative (n=266)
|
|
<ul id="l356" class="circle"><li id="lt899" class="half_rhythm"><div>Mortality ratio O:E = 0.93</div></li><li id="lt900" class="half_rhythm"><div>Difference O-E = −7.7% (n=-3)</div></li></ul></div></li><li id="lt901" class="half_rhythm"><div>Positive (n=327)
|
|
<ul id="l357" class="circle"><li id="lt902" class="half_rhythm"><div>Mortality ratio O:E = 0.92</div></li><li id="lt903" class="half_rhythm"><div>Difference O-E = 8% (n=9)</div></li></ul></div></li><li id="lt904" class="half_rhythm"><div>Unknown (n=4)
|
|
<ul id="l358" class="circle"><li id="lt905" class="half_rhythm"><div>Mortality ratio O:E = 1</div></li><li id="lt906" class="half_rhythm"><div>Difference O-E = 0% (n=0)</div></li></ul></div></li><li id="lt907" class="half_rhythm"><div><i>Subgroup: ER status</i></div></li><li id="lt908" class="half_rhythm"><div>Negative (n=231)
|
|
<ul id="l359" class="circle"><li id="lt909" class="half_rhythm"><div>Mortality ratio O:E = 0.68</div></li><li id="lt910" class="half_rhythm"><div>Difference O-E = −46.9% (n=-30)</div></li></ul></div></li><li id="lt911" class="half_rhythm"><div>Positive (n=366)
|
|
<ul id="l360" class="circle"><li id="lt912" class="half_rhythm"><div>Mortality ratio O:E = 1.26</div></li><li id="lt913" class="half_rhythm"><div>Difference O-E = 20.5% (n=18)</div></li></ul></div></li><li id="lt914" class="half_rhythm"><div><i>Subgroup: HER2 status</i></div></li><li id="lt915" class="half_rhythm"><div>Negative (n=327)
|
|
<ul id="l361" class="circle"><li id="lt916" class="half_rhythm"><div>Mortality ratio O:E = 0.99</div></li><li id="lt917" class="half_rhythm"><div>Difference O-E = −1.2% (n=-1)</div></li></ul></div></li><li id="lt918" class="half_rhythm"><div>Positive (n=140)
|
|
<ul id="l362" class="circle"><li id="lt919" class="half_rhythm"><div>Mortality ratio O:E = 0.94</div></li><li id="lt920" class="half_rhythm"><div>Difference O-E = −6% (n=-3)</div></li></ul></div></li><li id="lt921" class="half_rhythm"><div>Borderline (n=14)
|
|
<ul id="l363" class="circle"><li id="lt922" class="half_rhythm"><div>Mortality ratio O:E = 1.25</div></li><li id="lt923" class="half_rhythm"><div>Difference O-E = 20% (n=1)</div></li></ul></div></li><li id="lt924" class="half_rhythm"><div>Unknown (n=116)
|
|
<ul id="l364" class="circle"><li id="lt925" class="half_rhythm"><div>Mortality ratio O:E = 0.62</div></li><li id="lt926" class="half_rhythm"><div>Difference O-E = −60% (n=-9)</div></li></ul></div></li><li id="lt927" class="half_rhythm"><div><b>Tool discrimination</b></div></li><li id="lt928" class="half_rhythm"><div>AUC ER- vs ER+ = 0.694 vs 0.724 (discrimination was better for ER+ tumours, compared to ER- tumours)</div></li><li id="lt929" class="half_rhythm"><div>AUC HER2- vs HER2+ =0.724 vs 0.592 (discrimination was better for HER2- tumours, compared to HER2+ tumours)</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_5 hd_b_chc.tab7_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l365"><li id="lt930" class="half_rhythm"><div>PREDICT v1.2</div></li><li id="lt931" class="half_rhythm"><div>Other factors in the tool: menopausal status, morphology, LV invasion, local treatment, systemic treatment, ethnicity</div></li><li id="lt932" class="half_rhythm"><div>Tool discrimination: very limited data reported (based on ER status and HER2 status)</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_6 hd_b_chc.tab7_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l366"><li id="lt933" class="half_rhythm"><div>High quality, as assessed by CASP Clinical Prediction Rule checklist</div></li></ul></td></tr><tr><th headers="hd_h_chc.tab7_1_1_1_1 hd_h_chc.tab7_1_1_1_2 hd_h_chc.tab7_1_1_1_3 hd_h_chc.tab7_1_1_1_4 hd_h_chc.tab7_1_1_1_5 hd_h_chc.tab7_1_1_1_6" id="hd_b_chc.tab7_1_1_9_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">10-year breast cancer mortality [PREDICT v1.1]</th></tr><tr><td headers="hd_h_chc.tab7_1_1_1_1 hd_b_chc.tab7_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#chc.s1.2.ref10" rid="chc.s1.2.ref10">Wishart (2014)</a>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_2 hd_b_chc.tab7_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study</p>
|
|
<p>Study period: 1989 to 1998</p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_3 hd_b_chc.tab7_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data for 2232 cases of invasive breast cancer treated in Nottingham - 506 node-negative cases were excluded, so data from n=1726 people was included in the study</td><td headers="hd_h_chc.tab7_1_1_1_4 hd_b_chc.tab7_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l367"><li id="lt934" class="half_rhythm"><div><b>Prognostic accuracy (sensitivity, specificity)</b></div></li><li id="lt935" class="half_rhythm"><div>Not reported</div></li><li id="lt936" class="half_rhythm"><div><b>Tool calibration</b></div></li><li id="lt937" class="half_rhythm"><div>Total cohort (N=1726)</div></li><li id="lt938" class="half_rhythm"><div>BC mortality ratio O:E = 1.13</div></li><li id="lt939" class="half_rhythm"><div><i>Subgroup: age</i></div></li><li id="lt940" class="half_rhythm"><div><40 (n=67)
|
|
<ul id="l368" class="circle"><li id="lt941" class="half_rhythm"><div>BC mortality ratio O:E = 1.15</div></li></ul></div></li><li id="lt942" class="half_rhythm"><div>40 to 49 (n=274)
|
|
<ul id="l369" class="circle"><li id="lt943" class="half_rhythm"><div>BC mortality ratio O:E = 1.18</div></li></ul></div></li><li id="lt944" class="half_rhythm"><div>50 to 59 (n=436)
|
|
<ul id="l370" class="circle"><li id="lt945" class="half_rhythm"><div>BC mortality ratio O:E = 1.18</div></li></ul></div></li><li id="lt946" class="half_rhythm"><div>60+ (n=497)
|
|
<ul id="l371" class="circle"><li id="lt947" class="half_rhythm"><div>BC mortality ratio O:E = 1.06</div></li></ul></div></li><li id="lt948" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt949" class="half_rhythm"><div><10 (n=144)
|
|
<ul id="l372" class="circle"><li id="lt950" class="half_rhythm"><div>BC mortality ratio O:E = 0.78</div></li></ul></div></li><li id="lt951" class="half_rhythm"><div>10 to 19 (n=574)
|
|
<ul id="l373" class="circle"><li id="lt952" class="half_rhythm"><div>BC mortality ratio O:E = 1.09</div></li></ul></div></li><li id="lt953" class="half_rhythm"><div>20 to 29 (n=404)
|
|
<ul id="l374" class="circle"><li id="lt954" class="half_rhythm"><div>BC mortality ratio O:E = 1.32</div></li></ul></div></li><li id="lt955" class="half_rhythm"><div>30 to 49 (n=140)
|
|
<ul id="l375" class="circle"><li id="lt956" class="half_rhythm"><div>BC mortality ratio O:E = 0.95</div></li></ul></div></li><li id="lt957" class="half_rhythm"><div>50+ (n=11)
|
|
<ul id="l376" class="circle"><li id="lt958" class="half_rhythm"><div>BC mortality ratio O:E = 0.5</div></li></ul></div></li><li id="lt959" class="half_rhythm"><div>Missing (n=1)
|
|
<ul id="l377" class="circle"><li id="lt960" class="half_rhythm"><div>BC mortality ratio O:E = 1</div></li></ul></div></li><li id="lt961" class="half_rhythm"><div><i>Subgroup: node status</i></div></li><li id="lt962" class="half_rhythm"><div>Negative (n=709)
|
|
<ul id="l378" class="circle"><li id="lt963" class="half_rhythm"><div>BC mortality ratio O:E = 1.19</div></li></ul></div></li><li id="lt964" class="half_rhythm"><div>1+ (n=241)
|
|
<ul id="l379" class="circle"><li id="lt965" class="half_rhythm"><div>BC mortality ratio O:E = 1.23</div></li></ul></div></li><li id="lt966" class="half_rhythm"><div>2 to 4+ (n=184)
|
|
<ul id="l380" class="circle"><li id="lt967" class="half_rhythm"><div>BC mortality ratio O:E = 1.05</div></li></ul></div></li><li id="lt968" class="half_rhythm"><div>5 to 9+ (n=37)
|
|
<ul id="l381" class="circle"><li id="lt969" class="half_rhythm"><div>BC mortality ratio O:E = 1.10</div></li></ul></div></li><li id="lt970" class="half_rhythm"><div>10+ (n=6)
|
|
<ul id="l382" class="circle"><li id="lt971" class="half_rhythm"><div>BC mortality ratio O:E = 0.8</div></li></ul></div></li><li id="lt972" class="half_rhythm"><div>Missing (n=97)
|
|
<ul id="l383" class="circle"><li id="lt973" class="half_rhythm"><div>BC mortality ratio O:E = 1.07</div></li></ul></div></li><li id="lt974" class="half_rhythm"><div><i>Subgroup: grade</i></div></li><li id="lt975" class="half_rhythm"><div>Grade 1 (n=235)
|
|
<ul id="l384" class="circle"><li id="lt976" class="half_rhythm"><div>BC mortality ratio O:E = 1.8</div></li></ul></div></li><li id="lt977" class="half_rhythm"><div>Grade 2 (n=528)
|
|
<ul id="l385" class="circle"><li id="lt978" class="half_rhythm"><div>BC mortality ratio O:E = 1.16</div></li></ul></div></li><li id="lt979" class="half_rhythm"><div>Grade 3 (n=395)
|
|
<ul id="l386" class="circle"><li id="lt980" class="half_rhythm"><div>BC mortality ratio O:E = 1.14</div></li></ul></div></li><li id="lt981" class="half_rhythm"><div>Missing grade (n=116)
|
|
<ul id="l387" class="circle"><li id="lt982" class="half_rhythm"><div>BC mortality ratio O:E = 0.31</div></li></ul></div></li><li id="lt983" class="half_rhythm"><div><i>Subgroup: HER2 status</i></div></li><li id="lt984" class="half_rhythm"><div>Negative (n=792)
|
|
<ul id="l388" class="circle"><li id="lt985" class="half_rhythm"><div>BC mortality ratio O:E = 1.35</div></li></ul></div></li><li id="lt986" class="half_rhythm"><div>Positive (n=77)
|
|
<ul id="l389" class="circle"><li id="lt987" class="half_rhythm"><div>BC mortality ratio O:E = 1.35</div></li></ul></div></li><li id="lt988" class="half_rhythm"><div>Missing (n=405)
|
|
<ul id="l390" class="circle"><li id="lt989" class="half_rhythm"><div>BC mortality ratio O:E = 0.44</div></li></ul></div></li><li id="lt990" class="half_rhythm"><div><b>Tool discrimination</b></div></li><li id="lt991" class="half_rhythm"><div>AUC = 0.7611 (CI not reported)</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_5 hd_b_chc.tab7_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l391"><li id="lt992" class="half_rhythm"><div>PREDICT v1.1</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_6 hd_b_chc.tab7_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l392"><li id="lt993" class="half_rhythm"><div>Moderate quality, as assessed by CASP Clinical Prediction Rule checklist</div></li></ul></td></tr><tr><th headers="hd_h_chc.tab7_1_1_1_1 hd_h_chc.tab7_1_1_1_2 hd_h_chc.tab7_1_1_1_3 hd_h_chc.tab7_1_1_1_4 hd_h_chc.tab7_1_1_1_5 hd_h_chc.tab7_1_1_1_6" id="hd_b_chc.tab7_1_1_11_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">10-year breast cancer mortality [PREDICT v1.2]</th></tr><tr><td headers="hd_h_chc.tab7_1_1_1_1 hd_b_chc.tab7_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#chc.s1.2.ref10" rid="chc.s1.2.ref10">Wishart (2014)</a>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_2 hd_b_chc.tab7_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study</p>
|
|
<p>Study period: 1989 to 1998</p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_3 hd_b_chc.tab7_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data for 2232 cases of invasive breast cancer treated in Nottingham - 506 node-negative cases were excluded, so data from n=1726 people was included in the study</td><td headers="hd_h_chc.tab7_1_1_1_4 hd_b_chc.tab7_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l393"><li id="lt994" class="half_rhythm"><div><b>Prognostic accuracy (sensitivity, specificity)</b></div></li><li id="lt995" class="half_rhythm"><div>Not reported</div></li><li id="lt996" class="half_rhythm"><div><b>Tool calibration</b></div></li><li id="lt997" class="half_rhythm"><div>Total cohort (N=1726)</div></li><li id="lt998" class="half_rhythm"><div>BC mortality ratio O:E = 1.08</div></li><li id="lt999" class="half_rhythm"><div><i>Subgroup: age</i></div></li><li id="lt1000" class="half_rhythm"><div><40 (n=67)
|
|
<ul id="l394" class="circle"><li id="lt1001" class="half_rhythm"><div>BC mortality ratio O:E = 1.07</div></li></ul></div></li><li id="lt1002" class="half_rhythm"><div>40 to 49 (n=274)
|
|
<ul id="l395" class="circle"><li id="lt1003" class="half_rhythm"><div>BC mortality ratio O:E = 1.13</div></li></ul></div></li><li id="lt1004" class="half_rhythm"><div>50 to 59 (n=436)
|
|
<ul id="l396" class="circle"><li id="lt1005" class="half_rhythm"><div>BC mortality ratio O:E = 1.15</div></li></ul></div></li><li id="lt1006" class="half_rhythm"><div>60+ (n=497)
|
|
<ul id="l397" class="circle"><li id="lt1007" class="half_rhythm"><div>BC mortality ratio O:E = 1.01</div></li></ul></div></li><li id="lt1008" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt1009" class="half_rhythm"><div><10 (n=144)
|
|
<ul id="l398" class="circle"><li id="lt1010" class="half_rhythm"><div>BC mortality ratio O:E = 0.78</div></li></ul></div></li><li id="lt1011" class="half_rhythm"><div>10 to 19 (n=574)
|
|
<ul id="l399" class="circle"><li id="lt1012" class="half_rhythm"><div>BC mortality ratio O:E = 1.05</div></li></ul></div></li><li id="lt1013" class="half_rhythm"><div>20 to 29 (n=404)
|
|
<ul id="l400" class="circle"><li id="lt1014" class="half_rhythm"><div>BC mortality ratio O:E = 1.26</div></li></ul></div></li><li id="lt1015" class="half_rhythm"><div>30 to 49 (n=140)
|
|
<ul id="l401" class="circle"><li id="lt1016" class="half_rhythm"><div>BC mortality ratio O:E = 0.91</div></li></ul></div></li><li id="lt1017" class="half_rhythm"><div>50+ (n=11)
|
|
<ul id="l402" class="circle"><li id="lt1018" class="half_rhythm"><div>BC mortality ratio O:E = 0.5</div></li></ul></div></li><li id="lt1019" class="half_rhythm"><div>Missing (n=1)
|
|
<ul id="l403" class="circle"><li id="lt1020" class="half_rhythm"><div>BC mortality ratio O:E = 1</div></li></ul></div></li><li id="lt1021" class="half_rhythm"><div><i>Subgroup: grade</i></div></li><li id="lt1022" class="half_rhythm"><div>Grade 1 (n=235)
|
|
<ul id="l404" class="circle"><li id="lt1023" class="half_rhythm"><div>BC mortality ratio O:E = 1.8</div></li></ul></div></li><li id="lt1024" class="half_rhythm"><div>Grade 2 (n=528)
|
|
<ul id="l405" class="circle"><li id="lt1025" class="half_rhythm"><div>BC mortality ratio O:E = 1.14</div></li></ul></div></li><li id="lt1026" class="half_rhythm"><div>Grade 3 (n=395)
|
|
<ul id="l406" class="circle"><li id="lt1027" class="half_rhythm"><div>BC mortality ratio O:E = 1.07</div></li></ul></div></li><li id="lt1028" class="half_rhythm"><div>Missing grade (n=116)
|
|
<ul id="l407" class="circle"><li id="lt1029" class="half_rhythm"><div>BC mortality ratio O:E = 0.31</div></li></ul></div></li><li id="lt1030" class="half_rhythm"><div><i>Subgroup: node status</i></div></li><li id="lt1031" class="half_rhythm"><div>Negative (n=709)
|
|
<ul id="l408" class="circle"><li id="lt1032" class="half_rhythm"><div>BC mortality ratio O:E = 1.15</div></li></ul></div></li><li id="lt1033" class="half_rhythm"><div>1+ (n=241)
|
|
<ul id="l409" class="circle"><li id="lt1034" class="half_rhythm"><div>BC mortality ratio O:E = 1.17</div></li></ul></div></li><li id="lt1035" class="half_rhythm"><div>2 to 4+ (n=184)
|
|
<ul id="l410" class="circle"><li id="lt1036" class="half_rhythm"><div>BC mortality ratio O:E = 1</div></li></ul></div></li><li id="lt1037" class="half_rhythm"><div>5 to 9+ (n=37)
|
|
<ul id="l411" class="circle"><li id="lt1038" class="half_rhythm"><div>BC mortality ratio O:E = 1.05</div></li></ul></div></li><li id="lt1039" class="half_rhythm"><div>10+ (n=6)
|
|
<ul id="l412" class="circle"><li id="lt1040" class="half_rhythm"><div>BC mortality ratio O:E = 0.8</div></li></ul></div></li><li id="lt1041" class="half_rhythm"><div>Missing (n=97)
|
|
<ul id="l413" class="circle"><li id="lt1042" class="half_rhythm"><div>BC mortality ratio O:E = 1.07</div></li></ul></div></li><li id="lt1043" class="half_rhythm"><div><i>Subgroup: HER2 status</i></div></li><li id="lt1044" class="half_rhythm"><div>Negative (n=792)
|
|
<ul id="l414" class="circle"><li id="lt1045" class="half_rhythm"><div>BC mortality ratio O:E = 1.29</div></li></ul></div></li><li id="lt1046" class="half_rhythm"><div>Positive (n=77)
|
|
<ul id="l415" class="circle"><li id="lt1047" class="half_rhythm"><div>BC mortality ratio O:E = 1.24</div></li></ul></div></li><li id="lt1048" class="half_rhythm"><div>Missing (n=405)
|
|
<ul id="l416" class="circle"><li id="lt1049" class="half_rhythm"><div>BC mortality ratio O:E = 0.44</div></li></ul></div></li><li id="lt1050" class="half_rhythm"><div><b>Tool discrimination</b></div></li><li id="lt1051" class="half_rhythm"><div>AUC = 0.7676 (CI not reported) (significant improvement compared to v1.1 (p-value = 0.0008) (see <a class="bibr" href="#chc.s1.2.ref10" rid="chc.s1.2.ref10">Wishart 2014</a>, data for v1.1.)</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_5 hd_b_chc.tab7_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l417"><li id="lt1052" class="half_rhythm"><div>PREDICT v1.2</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_6 hd_b_chc.tab7_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l418"><li id="lt1053" class="half_rhythm"><div>High quality, as assessed by CASP Clinical Prediction Rule checklist</div></li></ul></td></tr><tr><th headers="hd_h_chc.tab7_1_1_1_1 hd_h_chc.tab7_1_1_1_2 hd_h_chc.tab7_1_1_1_3 hd_h_chc.tab7_1_1_1_4 hd_h_chc.tab7_1_1_1_5 hd_h_chc.tab7_1_1_1_6" id="hd_b_chc.tab7_1_1_13_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">10-year breast cancer mortality [PREDICT v2.0]</th></tr><tr><td headers="hd_h_chc.tab7_1_1_1_1 hd_b_chc.tab7_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#chc.s1.2.ref4" rid="chc.s1.2.ref4">Candido dos Reis (2017)</a>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_2 hd_b_chc.tab7_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study Validations study</p>
|
|
<p>Study period:
|
|
<ul id="l419"><li id="lt1054" class="half_rhythm"><div>BCOS: 1990 to 2000</div></li><li id="lt1055" class="half_rhythm"><div>NTBCS: 1989 to 1998</div></li><li id="lt1056" class="half_rhythm"><div>POSH: 2000 to 2008</div></li></ul></p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_3 hd_b_chc.tab7_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validations study</p>
|
|
<p>Study period:
|
|
<ul id="l420"><li id="lt1057" class="half_rhythm"><div>BCOS: n=981</div></li><li id="lt1058" class="half_rhythm"><div>NTBCS: n=1726</div></li><li id="lt1059" class="half_rhythm"><div>POSH: n=2609</div></li></ul></p>
|
|
</td><td headers="hd_h_chc.tab7_1_1_1_4 hd_b_chc.tab7_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l421"><li id="lt1060" class="half_rhythm"><div><b>Prognostic accuracy (sensitivity, specificity)</b></div></li><li id="lt1061" class="half_rhythm"><div>Not reported</div></li><li id="lt1062" class="half_rhythm"><div><b>Tool calibration</b></div></li><li id="lt1063" class="half_rhythm"><div>Total cohort: not reported</div></li><li id="lt1064" class="half_rhythm"><div><i>Subgroup: age at diagnosis</i></div></li><li id="lt1065" class="half_rhythm"><div><i>ER-</i></div></li><li id="lt1066" class="half_rhythm"><div>20 to 29 (n=92):
|
|
<ul id="l422" class="circle"><li id="lt1067" class="half_rhythm"><div>BC mortality ratio = 0.94;</div></li><li id="lt1068" class="half_rhythm"><div>difference O:E = −6% (p-value = 0.76)</div></li></ul></div></li><li id="lt1069" class="half_rhythm"><div>30 to 39 (n=855):
|
|
<ul id="l423" class="circle"><li id="lt1070" class="half_rhythm"><div>BC mortality ratio = 0.92;</div></li><li id="lt1071" class="half_rhythm"><div>difference O:E = −9% (p-value = 0.18)</div></li></ul></div></li><li id="lt1072" class="half_rhythm"><div>40 to 49 (n=414):
|
|
<ul id="l424" class="circle"><li id="lt1073" class="half_rhythm"><div>BC mortality ratio = 0.98;</div></li><li id="lt1074" class="half_rhythm"><div>difference O:E = −2% (p-value = 0.83)</div></li></ul></div></li><li id="lt1075" class="half_rhythm"><div>50 to 59 (n=165):
|
|
<ul id="l425" class="circle"><li id="lt1076" class="half_rhythm"><div>BC mortality ratio = 0.97;</div></li><li id="lt1077" class="half_rhythm"><div>difference O:E = −3% (p-value = 0.85)</div></li></ul></div></li><li id="lt1078" class="half_rhythm"><div>60 to 69 (n=117):
|
|
<ul id="l426" class="circle"><li id="lt1079" class="half_rhythm"><div>BC mortality ratio = 0.82;</div></li><li id="lt1080" class="half_rhythm"><div>difference O:E = −21% (p-value = 0.32)</div></li></ul></div></li><li id="lt1081" class="half_rhythm"><div>70 to 79 (n=11):
|
|
<ul id="l427" class="circle"><li id="lt1082" class="half_rhythm"><div>BC mortality ratio = 0.36;</div></li><li id="lt1083" class="half_rhythm"><div>difference O:E = −180% (p-value = 0.28)</div></li></ul></div></li><li id="lt1084" class="half_rhythm"><div><i>ER+</i></div></li><li id="lt1085" class="half_rhythm"><div>20 to 29 (n=140):
|
|
<ul id="l428" class="circle"><li id="lt1086" class="half_rhythm"><div>BC mortality ratio = 0.71;</div></li><li id="lt1087" class="half_rhythm"><div>difference O:E = −40% (p-value = 0.047)</div></li></ul></div></li><li id="lt1088" class="half_rhythm"><div>30 to 39 (n=1633):
|
|
<ul id="l429" class="circle"><li id="lt1089" class="half_rhythm"><div>BC mortality ratio = 0.96;</div></li><li id="lt1090" class="half_rhythm"><div>difference O:E = −4% (p-value = 0.48)</div></li></ul></div></li><li id="lt1091" class="half_rhythm"><div>40 to 49 (n=1063):
|
|
<ul id="l430" class="circle"><li id="lt1092" class="half_rhythm"><div>BC mortality ratio = 0.90;</div></li><li id="lt1093" class="half_rhythm"><div>difference O:E = −11% (p-value = 0.16)</div></li></ul></div></li><li id="lt1094" class="half_rhythm"><div>50 to 59 (n=467):
|
|
<ul id="l431" class="circle"><li id="lt1095" class="half_rhythm"><div>BC mortality ratio = 0.96;</div></li><li id="lt1096" class="half_rhythm"><div>difference O:E = −4% (p-value = 0.77)</div></li></ul></div></li><li id="lt1097" class="half_rhythm"><div>60 to 69 (n=517):
|
|
<ul id="l432" class="circle"><li id="lt1098" class="half_rhythm"><div>BC mortality ratio = 1.08;</div></li><li id="lt1099" class="half_rhythm"><div>difference O:E = 7% (p-value = 0.53)</div></li></ul></div></li><li id="lt1100" class="half_rhythm"><div>70 to 79 (n=55):
|
|
<ul id="l433" class="circle"><li id="lt1101" class="half_rhythm"><div>BC mortality ratio = 0.38;</div></li><li id="lt1102" class="half_rhythm"><div>difference O:E = −26% (p-value = 0.54)</div></li></ul></div></li><li id="lt1103" class="half_rhythm"><div><i>Subgroup: tumour size</i></div></li><li id="lt1104" class="half_rhythm"><div><i>ER-</i></div></li><li id="lt1105" class="half_rhythm"><div>0 to 9 mm (n=96):
|
|
<ul id="l434" class="circle"><li id="lt1106" class="half_rhythm"><div>BC mortality ratio = 0.90;</div></li><li id="lt1107" class="half_rhythm"><div>difference O:E = −10% (p-value = 0.73)</div></li></ul></div></li><li id="lt1108" class="half_rhythm"><div>10 to 19 mm (n=559):
|
|
<ul id="l435" class="circle"><li id="lt1109" class="half_rhythm"><div>BC mortality ratio = 0.92;</div></li><li id="lt1110" class="half_rhythm"><div>difference O:E = −8% (p-value = 0.41)</div></li></ul></div></li><li id="lt1111" class="half_rhythm"><div>20 to 29 mm (n=524):
|
|
<ul id="l436" class="circle"><li id="lt1112" class="half_rhythm"><div>BC mortality ratio = 0.97;</div></li><li id="lt1113" class="half_rhythm"><div>difference O:E = −3% (p-value = 0.72)</div></li></ul></div></li><li id="lt1114" class="half_rhythm"><div>30 to 49 mm (n=354):
|
|
<ul id="l437" class="circle"><li id="lt1115" class="half_rhythm"><div>BC mortality ratio = 0.99;</div></li><li id="lt1116" class="half_rhythm"><div>difference O:E = −1% (p-value = 0.91)</div></li></ul></div></li><li id="lt1117" class="half_rhythm"><div>50+ mm (n=121):
|
|
<ul id="l438" class="circle"><li id="lt1118" class="half_rhythm"><div>BC mortality ratio = 0.75;</div></li><li id="lt1119" class="half_rhythm"><div>difference O:E = −33% (p-value = 0.04)</div></li></ul></div></li><li id="lt1120" class="half_rhythm"><div><i>ER+</i></div></li><li id="lt1121" class="half_rhythm"><div>0 to 9 mm (n=352):
|
|
<ul id="l439" class="circle"><li id="lt1122" class="half_rhythm"><div>BC mortality ratio = 1.54;</div></li><li id="lt1123" class="half_rhythm"><div>difference O:E = 35% (p-value = 0.024)</div></li></ul></div></li><li id="lt1124" class="half_rhythm"><div>10 to 19 mm (n=1428):
|
|
<ul id="l440" class="circle"><li id="lt1125" class="half_rhythm"><div>BC mortality ratio = 1.06;</div></li><li id="lt1126" class="half_rhythm"><div>difference O:E = 6% (p-value = 0.46)</div></li></ul></div></li><li id="lt1127" class="half_rhythm"><div>20 to 29 mm (n=1111):
|
|
<ul id="l441" class="circle"><li id="lt1128" class="half_rhythm"><div>BC mortality ratio = 0.98;</div></li><li id="lt1129" class="half_rhythm"><div>difference O:E = −2% (p-value = 0.80)</div></li></ul></div></li><li id="lt1130" class="half_rhythm"><div>30 to 49 mm (n=695):
|
|
<ul id="l442" class="circle"><li id="lt1131" class="half_rhythm"><div>BC mortality ratio = 0.87;</div></li><li id="lt1132" class="half_rhythm"><div>difference O:E = −15% (p-value = 0.07)</div></li></ul></div></li><li id="lt1133" class="half_rhythm"><div>50+ mm (n=289):
|
|
<ul id="l443" class="circle"><li id="lt1134" class="half_rhythm"><div>BC mortality ratio = 0.74;</div></li><li id="lt1135" class="half_rhythm"><div>difference O:E = −35% (p-value = 0.00)</div></li></ul></div></li><li id="lt1136" class="half_rhythm"><div><i>Subgroup: tumour grade</i></div></li><li id="lt1137" class="half_rhythm"><div><i>ER-</i></div></li><li id="lt1138" class="half_rhythm"><div>1 (n=44):
|
|
<ul id="l444" class="circle"><li id="lt1139" class="half_rhythm"><div>BC mortality ratio = 0.96;</div></li><li id="lt1140" class="half_rhythm"><div>difference O:E = −4% (p-value = 0.91)</div></li></ul></div></li><li id="lt1141" class="half_rhythm"><div>2 (n=183):
|
|
<ul id="l445" class="circle"><li id="lt1142" class="half_rhythm"><div>BC mortality ratio = 0.86;</div></li><li id="lt1143" class="half_rhythm"><div>difference O:E = −17% (p-value = 0.33)</div></li></ul></div></li><li id="lt1144" class="half_rhythm"><div>3 (n=1427):
|
|
<ul id="l446" class="circle"><li id="lt1145" class="half_rhythm"><div>BC mortality ratio = 0.94;</div></li><li id="lt1146" class="half_rhythm"><div>difference O:E = −7% (p-value = 0.19)</div></li></ul></div></li><li id="lt1147" class="half_rhythm"><div><i>ER+</i></div></li><li id="lt1148" class="half_rhythm"><div>1 (n=658):
|
|
<ul id="l447" class="circle"><li id="lt1149" class="half_rhythm"><div>BC mortality ratio = 0.86;</div></li><li id="lt1150" class="half_rhythm"><div>difference O:E = −16% (p-value = 0.43)</div></li></ul></div></li><li id="lt1151" class="half_rhythm"><div>2 (n=1730):
|
|
<ul id="l448" class="circle"><li id="lt1152" class="half_rhythm"><div>BC mortality ratio = 0.95;</div></li><li id="lt1153" class="half_rhythm"><div>difference O:E = −5% (p-value = 0.44)</div></li></ul></div></li><li id="lt1154" class="half_rhythm"><div>3 (n=1487):
|
|
<ul id="l449" class="circle"><li id="lt1155" class="half_rhythm"><div>BC mortality ratio = 0.93;</div></li><li id="lt1156" class="half_rhythm"><div>difference O:E = −7% (p-value = 0.17)</div></li></ul></div></li><li id="lt1157" class="half_rhythm"><div><i>Subgroup: nodes positive</i></div></li><li id="lt1158" class="half_rhythm"><div><i>ER-</i></div></li><li id="lt1159" class="half_rhythm"><div>0 (n=937):
|
|
<ul id="l450" class="circle"><li id="lt1160" class="half_rhythm"><div>BC mortality ratio = 1.01;</div></li><li id="lt1161" class="half_rhythm"><div>difference O:E = 1% (p-value = 0.89)</div></li></ul></div></li><li id="lt1162" class="half_rhythm"><div>1 (n=232):
|
|
<ul id="l451" class="circle"><li id="lt1163" class="half_rhythm"><div>BC mortality ratio = 0.86;</div></li><li id="lt1164" class="half_rhythm"><div>difference O:E = −17% (p-value = 0.23)</div></li></ul></div></li><li id="lt1165" class="half_rhythm"><div>2 to 4 (n=300):
|
|
<ul id="l452" class="circle"><li id="lt1166" class="half_rhythm"><div>BC mortality ratio = 0.88;</div></li><li id="lt1167" class="half_rhythm"><div>difference O:E = −13% (p-value = 0.19)</div></li></ul></div></li><li id="lt1168" class="half_rhythm"><div>5 to 9 (n=101):
|
|
<ul id="l453" class="circle"><li id="lt1169" class="half_rhythm"><div>BC mortality ratio = 0.96;</div></li><li id="lt1170" class="half_rhythm"><div>difference O:E = −4% (p-value = 0.77)</div></li></ul></div></li><li id="lt1171" class="half_rhythm"><div>10+ (n=84):
|
|
<ul id="l454" class="circle"><li id="lt1172" class="half_rhythm"><div>BC mortality ratio = 0.85;</div></li><li id="lt1173" class="half_rhythm"><div>difference O:E = −17% (p-value = 0.28)</div></li></ul></div></li><li id="lt1174" class="half_rhythm"><div><i>ER+</i></div></li><li id="lt1175" class="half_rhythm"><div>0 (n=2085):
|
|
<ul id="l455" class="circle"><li id="lt1176" class="half_rhythm"><div>BC mortality ratio = 0.99;</div></li><li id="lt1177" class="half_rhythm"><div>difference O:E = −1% (p-value = 0.85)</div></li></ul></div></li><li id="lt1178" class="half_rhythm"><div>1 (n=675):
|
|
<ul id="l456" class="circle"><li id="lt1179" class="half_rhythm"><div>BC mortality ratio = 0.92;</div></li><li id="lt1180" class="half_rhythm"><div>difference O:E = −9% (p-value = 0.39)</div></li></ul></div></li><li id="lt1181" class="half_rhythm"><div>2 to 4 (n=734):
|
|
<ul id="l457" class="circle"><li id="lt1182" class="half_rhythm"><div>BC mortality ratio = 0.96;</div></li><li id="lt1183" class="half_rhythm"><div>difference O:E = −4% (p-value = 0.63)</div></li></ul></div></li><li id="lt1184" class="half_rhythm"><div>5 to 9 (n=245):
|
|
<ul id="l458" class="circle"><li id="lt1185" class="half_rhythm"><div>BC mortality ratio = 0.86;</div></li><li id="lt1186" class="half_rhythm"><div>difference O:E = −17% (p-value = 0.14)</div></li></ul></div></li><li id="lt1187" class="half_rhythm"><div>10+ (n=136):
|
|
<ul id="l459" class="circle"><li id="lt1188" class="half_rhythm"><div>BC mortality ratio = 0.87;</div></li><li id="lt1189" class="half_rhythm"><div>difference O:E = −15% (p-value = 0.25)</div></li></ul></div></li><li id="lt1190" class="half_rhythm"><div><b>Tool discrimination</b></div></li><li id="lt1191" class="half_rhythm"><div>ER-: AUC = 0.696</div></li><li id="lt1192" class="half_rhythm"><div>ER+: AUC = 0.760</div></li><li id="lt1193" class="half_rhythm"><div>All population: AUC = 0.752</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_5 hd_b_chc.tab7_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l460"><li id="lt1194" class="half_rhythm"><div>Validation study (data from the primary analysis has not been reported)</div></li></ul></td><td headers="hd_h_chc.tab7_1_1_1_6 hd_b_chc.tab7_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l461"><li id="lt1195" class="half_rhythm"><div>High quality, as assessed by CASP Clinical Prediction Rule checklist</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">AUC, area under the curve; BC, breast cancer; BCOS, Breast Cancer Outcomes Simulator BCS, breast cancer survival; CASP, Critical Appraisal Skills Programme; ER, oestrogen receptor; HER2, Human epidermal growth factor receptor 2; LV; lymphovascular; NGA, National Guideline Alliance; NTBC, Nottingham Tenovus Breast Cancer; O:E, observed/expected; POSH, Prospective study of Outcomes in Sporadic versus Hereditary breast cancer; SE, standard error; UK, United Kingdom; WMCIU, West Midlands Cancer Intelligence Unit</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchctab8"><div id="chc.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Summary of included studies and results for Nottingham Prognostic Index (NPI)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_chc.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study details</th><th id="hd_h_chc.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_chc.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Findings</th><th id="hd_h_chc.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th><th id="hd_h_chc.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_chc.tab8_1_1_1_1 hd_h_chc.tab8_1_1_1_2 hd_h_chc.tab8_1_1_1_3 hd_h_chc.tab8_1_1_1_4 hd_h_chc.tab8_1_1_1_5 hd_h_chc.tab8_1_1_1_6" id="hd_b_chc.tab8_1_1_1_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">10 year breast cancer survival (BCS)</th></tr><tr><td headers="hd_h_chc.tab8_1_1_1_1 hd_b_chc.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<a class="bibr" href="#chc.s1.2.ref1" rid="chc.s1.2.ref1">Blamey (2007)</a>
|
|
</td><td headers="hd_h_chc.tab8_1_1_1_2 hd_b_chc.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Validation study</p>
|
|
<p>Study period:
|
|
<ul id="l462"><li id="lt1196" class="half_rhythm"><div>1980 to 1986 (n=892)</div></li><li id="lt1197" class="half_rhythm"><div>1990 to 1999 (n=2238)</div></li></ul></p>
|
|
</td><td headers="hd_h_chc.tab8_1_1_1_3 hd_b_chc.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Women diagnosed with or treated for primary operable invasive breast cancer at Nottingham city hospital</p>
|
|
<p>Based on the NPI score, women were allocated to the following 6 categories:
|
|
<ul id="l463"><li id="lt1198" class="half_rhythm"><div>EPG: excellent prognostic group</div></li><li id="lt1199" class="half_rhythm"><div>GPG: good prognostic group</div></li><li id="lt1200" class="half_rhythm"><div>MPG I: moderate prognostic group I</div></li><li id="lt1201" class="half_rhythm"><div>MPG II: moderate prognostic group II</div></li><li id="lt1202" class="half_rhythm"><div>PPG: poor prognostic group</div></li><li id="lt1203" class="half_rhythm"><div>VPG: very poor prognostic group</div></li></ul></p>
|
|
</td><td headers="hd_h_chc.tab8_1_1_1_4 hd_b_chc.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Prognostic accuracy (sensitivity, specificity)</b>
|
|
</p>
|
|
<p>Not reported</p>
|
|
<p>
|
|
<b>Tool calibration</b>
|
|
</p>
|
|
<p>Results only available for the 2000 to 2009 cohort</p>
|
|
<p>Total cohort = not reported EPG (n=320)
|
|
<ul id="l464"><li id="lt1204" class="half_rhythm"><div>BCS ratio O:E = 0.98 GPG (n=475)</div></li><li id="lt1205" class="half_rhythm"><div>BCS ratio O:E = 0.99 MPG I (n=634)</div></li><li id="lt1206" class="half_rhythm"><div>BCS ratio O:E = 1.03 MPG II (n=489)</div></li><li id="lt1207" class="half_rhythm"><div>BCS ratio O:E = 1.00 PPG (n=233)</div></li><li id="lt1208" class="half_rhythm"><div>BCS ratio O:E = 1.02 VPG (n=86)</div></li><li id="lt1209" class="half_rhythm"><div>BCS ratio O:E = 0.89</div></li><li id="lt1210" class="half_rhythm"><div><b>Tool discrimination</b></div></li></ul>
|
|
Not reported</p>
|
|
</td><td headers="hd_h_chc.tab8_1_1_1_5 hd_b_chc.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul id="l465"><li id="lt1211" class="half_rhythm"><div>Observed survival was adjusted by subtracting expected number of deaths for all causes was subtracted. Data was obtained from the Office of National Statistics for England and Wales</div></li><li id="lt1212" class="half_rhythm"><div>BCS ratio O:E was calculated by the NGA technical team based on available data on the paper</div></li></ul></td><td headers="hd_h_chc.tab8_1_1_1_6 hd_b_chc.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l466"><li id="lt1213" class="half_rhythm"><div>High quality, as assessed by CASP Clinical Prediction Rule checklist.</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">BCS: breast cancer survival; CASP: Critical Appraisal Skills Programme; NGA: National Guideline Alliance; NPI: Nottingham Prognostic Index; O:E: observed: expected; UK: United Kingdom</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchctab9"><div id="chc.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Summary of included studies and results for Oxford Prognostic Index (OPI)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_chc.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_chc.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study details</th><th id="hd_h_chc.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_chc.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Findings</th><th id="hd_h_chc.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th><th id="hd_h_chc.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_chc.tab9_1_1_1_1 hd_h_chc.tab9_1_1_1_2 hd_h_chc.tab9_1_1_1_3 hd_h_chc.tab9_1_1_1_4 hd_h_chc.tab9_1_1_1_5 hd_h_chc.tab9_1_1_1_6" id="hd_b_chc.tab9_1_1_1_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">5 year recurrence free survival (RFS)</th></tr><tr><td headers="hd_h_chc.tab9_1_1_1_1 hd_b_chc.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#chc.s1.2.ref3" rid="chc.s1.2.ref3">Campbell (2010)</a>
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</td><td headers="hd_h_chc.tab9_1_1_1_2 hd_b_chc.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Validation study</p>
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<p>Study period: 1992 to 2000</p>
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</td><td headers="hd_h_chc.tab9_1_1_1_3 hd_b_chc.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=1787 women with invasive ductal carcinoma, a sub-set obtained from the Adjuvant Breast Cancer trial from 70 UK centres</td><td headers="hd_h_chc.tab9_1_1_1_4 hd_b_chc.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<b>Prognostic accuracy (sensitivity, specificity)</b>
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</p>
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<p>Not reported</p>
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<p>
|
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<b>Tool calibration</b>
|
|
</p>
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<p>Total cohort (N=1789)
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<ul id="l467" class="circle"><li id="lt1214" class="half_rhythm"><div>RFS ratio O:E:1.01</div></li><li id="lt1215" class="half_rhythm"><div>Difference O-E: 0.7%</div></li></ul>
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<i>Subgroup: age</i>
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<ul id="l468"><li id="lt1216" class="half_rhythm"><div>≤50 years (n=1097)
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<ul id="l469" class="circle"><li id="lt1217" class="half_rhythm"><div>RFS ratio O:E: 1.03</div></li><li id="lt1218" class="half_rhythm"><div>Difference O-E: 1.92%</div></li></ul></div></li><li id="lt1219" class="half_rhythm"><div>> 50 years (n=690)
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<ul id="l470" class="circle"><li id="lt1220" class="half_rhythm"><div>RFS ratio O:E: 1.00</div></li><li id="lt1221" class="half_rhythm"><div>Difference O-E: −0.10%</div></li></ul></div></li></ul>
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<i>Subgroup: tumour grade</i>
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<ul id="l471"><li id="lt1222" class="half_rhythm"><div>Grade 1 (n=196)
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<ul id="l472" class="circle"><li id="lt1223" class="half_rhythm"><div>RFS ratio O:E: 1.06</div></li><li id="lt1224" class="half_rhythm"><div>Difference O-E: 5.15%</div></li></ul></div></li><li id="lt1225" class="half_rhythm"><div>Grade 2 (n=772)
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<ul id="l473" class="circle"><li id="lt1226" class="half_rhythm"><div>RFS ratio O:E: 1.03</div></li><li id="lt1227" class="half_rhythm"><div>Difference O-E: 2.44%</div></li></ul></div></li><li id="lt1228" class="half_rhythm"><div>Grade 3 (n=819)
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<ul id="l474" class="circle"><li id="lt1229" class="half_rhythm"><div>RFS ratio O:E: 0.98</div></li><li id="lt1230" class="half_rhythm"><div>Difference O-E: −1.04%</div></li></ul></div></li></ul>
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<i>Subgroup: tumour size</i>
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<ul id="l475"><li id="lt1231" class="half_rhythm"><div>≤2 cm (n=954)
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<ul id="l476" class="circle"><li id="lt1232" class="half_rhythm"><div>RFS ratio O:E: 1.06</div></li><li id="lt1233" class="half_rhythm"><div>Difference O-E: 4.6%</div></li></ul></div></li><li id="lt1234" class="half_rhythm"><div>>2 cm to ≤5 cm (n=772)
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<ul id="l477" class="circle"><li id="lt1235" class="half_rhythm"><div>RFS ratio O:E:0.95</div></li><li id="lt1236" class="half_rhythm"><div>Difference O-E: −3.16%</div></li></ul></div></li><li id="lt1237" class="half_rhythm"><div>>5 cm (n=61)
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<ul id="l478" class="circle"><li id="lt1238" class="half_rhythm"><div>RFS ratio O:E: 1.04</div></li><li id="lt1239" class="half_rhythm"><div>Difference O-E: −2.47%</div></li></ul></div></li></ul>
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<i>Subgroup: nodal status</i>
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<ul id="l479"><li id="lt1240" class="half_rhythm"><div>Negative (n=674)
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<ul id="l480" class="circle"><li id="lt1241" class="half_rhythm"><div>RFS ratio O:E: 1.02</div></li><li id="lt1242" class="half_rhythm"><div>Difference O-E: 1.82</div></li></ul></div></li><li id="lt1243" class="half_rhythm"><div>Positive (n=1113)
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<ul id="l481" class="circle"><li id="lt1244" class="half_rhythm"><div>RFS ratio O:E: 1.01</div></li><li id="lt1245" class="half_rhythm"><div>Difference O-E: 0.71%</div></li></ul></div></li></ul>
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<i>Subgroup: ER status</i>
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<ul id="l482"><li id="lt1246" class="half_rhythm"><div>Negative (n=1097)
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<ul id="l483" class="circle"><li id="lt1247" class="half_rhythm"><div>RFS ratio O:E: 1.03</div></li><li id="lt1248" class="half_rhythm"><div>Difference O-E: 1.92%</div></li></ul></div></li><li id="lt1249" class="half_rhythm"><div>Positive (n=690)
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<ul id="l484" class="circle"><li id="lt1250" class="half_rhythm"><div>RFS ratio O:E: 1.00</div></li><li id="lt1251" class="half_rhythm"><div>Difference O-E: −0.10%</div></li></ul></div></li><li id="lt1252" class="half_rhythm"><div><b>Tool discrimination</b></div></li><li id="lt1253" class="half_rhythm"><div>Overall C = 0.720 (95%CI 0.693 to 0.746)</div></li></ul></p>
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</td><td headers="hd_h_chc.tab9_1_1_1_5 hd_b_chc.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l485"><li id="lt1254" class="half_rhythm"><div>Study provided data as E:O. The NGA technical team has calculated the RFS ratio O:E and the difference O-E</div></li><li id="lt1255" class="half_rhythm"><div>No other factors were in the tool</div></li></ul></td><td headers="hd_h_chc.tab9_1_1_1_6 hd_b_chc.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l486"><li id="lt1256" class="half_rhythm"><div>Moderate quality, as assessed by CASP Clinical Prediction Rule checklist.</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">BCS, breast cancer survival; NGA, National Guideline Alliance; O:E, observed/ expected; OPI, Oxford Prognostic Index RFS, recurrence free survival; UK, United Kingdom</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobchcappbtab1"><div id="chc.appb.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#</th><th id="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast cancer/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast carcinoma/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp medullary carcinoma/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp intraductal carcinoma/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast tumor/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Breast Neoplasms/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Neoplasms, Ductal, Lobular, and Medullary”/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carcinoma, Intraductal, Noninfiltrating/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carcinoma, Lobular/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carcinoma, Medullary/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Breast/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">breast.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 or 13 or 14</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast adj milk).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast adj tender$).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 or 17</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 18</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp neoplasm/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Neoplasms/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 or 21</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 and 22</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).tw. use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).tw. use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).mp. use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).mp. use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Paget nipple disease/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Paget’s Disease, Mammary/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(paget$ and (breast$ or mammary or nipple$)).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 or 24 or 25 or 26 or 27 or 28 or 29 or 30</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 or 31</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Receptors, Progesterone/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">progesterone receptor/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((progesteron$ or progestin or PgR or PR) adj3 (status or test$ or level$ or receptor$ or expression)).ti,ab.</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((PR adj2 positiv$) or (PR adj2 negativ$) or (PgR adj2 positiv$) or (PgR adj2 negativ$) or (progesteron$ adj2 positiv$) or (progesteron$ adj2 negativ$) or (progestin adj2 negativ$) or (progestin adj2 positiv$)).ti,ab.</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(progesteron$ or progestin or PgR or PR).m_titl.</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 or 34 or 35 or 36 or 37</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32 and 38</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 39 to yr=“1984 -Current”</td></tr><tr><td headers="hd_h_chc.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_chc.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 40 to RCTs and SRs, and general exclusions filter applied</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchcappbtab2"><div id="chc.appb.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.appb.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#</th><th id="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Breast Neoplasms] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carcinoma, Lobular] this term only</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carcinoma, Medullary] this term only</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 or #2 or #3 or #4 or #5</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Breast] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">breast:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7 or #8</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast next milk):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast next tender*):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10 or #11</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9 not #12</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Neoplasms] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13 and #14</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Paget’s Disease, Mammary] this term only</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15 or #16 or #17 or #18 or #19</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6 or #20</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Receptors, Progesterone] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((progesteron* or progestin or PgR or PR) near/3 (status or test* or level* or receptor* or expression)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#24</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((PR near/2 positiv*) or (PR near/2 negativ*) or (PgR near/2 positiv*) or (PgR near/2 negativ*) or (progesteron* near/2 positiv*) or (progesteron* near/2 negativ*) or (progestin near/2 negativ*) or (progestin near/2 positiv*)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#25</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(progesterone* or progestin or PgR or PR):ti (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#26</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22 or #23 or #24 or #25</td></tr><tr><td headers="hd_h_chc.appb.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#27</td><td headers="hd_h_chc.appb.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21 and #26</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchcappbtab3"><div id="chc.appb.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.appb.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#</th><th id="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast cancer/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast carcinoma/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp medullary carcinoma/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp intraductal carcinoma/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast tumor/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Breast Neoplasms/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Neoplasms, Ductal, Lobular, and Medullary”/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carcinoma, Intraductal, Noninfiltrating/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carcinoma, Lobular/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carcinoma, Medullary/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp breast/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Breast/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">breast.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 or 13 or 14</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast adj milk).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast adj tender$).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 or 17</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 not 18</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp neoplasm/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Neoplasms/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 or 21</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 and 22</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).tw. use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).tw. use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).mp. use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).mp. use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Paget nipple disease/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Paget’s Disease, Mammary/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(paget$ and (breast$ or mammary or nipple$)).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 or 24 or 25 or 26 or 27 or 28 or 29 or 30</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 or 31</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(adjuvant$ adj (online or model$ or program$ or tool$)).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“<a href="https://www.adjuvantonline.com" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.adjuvantonline.com</a>”.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">adjuvant?online$.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(PREDICT adj2 (online or model$ or program$ or tool$ or estimat$)).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“<a href="https://www.predict.nhs.uk" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.predict.nhs.uk</a>”.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(predict adj plus).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prognost$ adj index).tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“Nottingham Prognostic Index”.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NPI.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FinProg$.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CancerMath$.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“<a href="http://www.CancerMath.net" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.CancerMath.net</a>”.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32 and 45</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 46 to yr=“1982 -Current”</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">decision support system/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision Making, Computer-Assisted/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">computer/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computers/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">clinical decision support system/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision Support Systems, Clinical/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">computer program/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Software/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision Support Techniques/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*decision making/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">medical decision making/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">clinical decision making/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision Making/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">adjuvant$.tw.</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32 and 61 and 62</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 63 to yr=“2007 -Current”</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">survival/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">survival analysis/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65 or 66</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Internet/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">internet/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Databases, factual/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*data base/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Online systems/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">online system/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Web browser/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">web browser/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">User computer interface/ use prmz</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">77</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">computer interface/ use oemezd</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">78</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68 or 69 or 70 or 71 or 72 or 73 or 74 or 75 or 76 or 77</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32 and 67 and 78</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">80</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 79 to yr=“1982 -Current”</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">81</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47 or 64 or 80</td></tr><tr><td headers="hd_h_chc.appb.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">82</td><td headers="hd_h_chc.appb.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">remove duplicates from 81 [Then general exclusions filter applied]</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobchcappbtab4"><div id="chc.appb.tab4" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.appb.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#</th><th id="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Searches</th></tr></thead><tbody><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Breast Neoplasms] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carcinoma, Lobular] this term only</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carcinoma, Medullary] this term only</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 or #2 or #3 or #4 or #5</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Breast] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">breast:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7 or #8</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast next milk):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast next tender*):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10 or #11</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9 not #12</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Neoplasms] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13 and #14</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Paget’s Disease, Mammary] this term only</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15 or #16 or #17 or #18 or #19</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6 or #20</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(adjuvant* next (online or model* or program* or tool*)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“<a href="http://www.adjuvantonline.com" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.adjuvantonline.com</a>”:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#24</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">adjuvantonline*:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#25</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(PREDICT near/2 (online or model* or program* or tool* or estimat*)):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#26</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“<a href="http://www.predict.nhs.uk" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.predict.nhs.uk</a>”:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#27</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(predict next plus):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#28</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(prognost* next index):ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#29</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“Nottingham Prognostic Index”:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#30</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NPI:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#31</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FinProg*:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#32</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CancerMath*:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#33</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">“<a href="http://www.CancerMath.net" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>​.CancerMath.net</a>”:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#34</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#35</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21 and #34 Publication Year from 1982 to 2017</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#36</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Decision Making, Computer-Assisted] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#37</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Computers] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#38</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Decision Support Systems, Clinical] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#39</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Software] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#40</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Decision Support Techniques] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#41</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Decision Making] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#42</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#36 or #37 or #38 or #39 or #40 or #41</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#43</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">adjuvant*:ti,ab,kw (Word variations have been searched)</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#44</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21 and #42 and #43 Publication Year from 2007 to 2017</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#45</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Survival Analysis] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#46</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Internet] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#47</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Databases, Factual] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#48</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Online Systems] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#49</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Web Browser] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#50</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [User-Computer Interface] explode all trees</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#51</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#46 or #47 or #48 or #49 or #50</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#52</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21 and #45 and #51 Publication Year from 1982 to 2017</td></tr><tr><td headers="hd_h_chc.appb.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#53</td><td headers="hd_h_chc.appb.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#35 or #44 or #52</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobchcappcfig1"><div id="chc.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20diagram%20of%20clinical%20article%20selection%20for%20progesterone%20receptor%20testing.&p=BOOKS&id=576822_chcappcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576822/bin/chcappcf1.jpg" alt="Figure 1. Flow diagram of clinical article selection for progesterone receptor testing." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow diagram of clinical article selection for progesterone receptor testing</span></h3></div></article><article data-type="fig" id="figobchcappcfig2"><div id="chc.appc.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20diagram%20of%20clinical%20article%20selection%20for%20prognostic%20tools%20review.&p=BOOKS&id=576822_chcappcf2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK576822/bin/chcappcf2.jpg" alt="Figure 2. Flow diagram of clinical article selection for prognostic tools review." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow diagram of clinical article selection for prognostic tools review</span></h3></div></article><article data-type="table-wrap" id="figobchcappntab1"><div id="chc.appn.tab1" class="table"><h3><span class="label">Table 11</span><span class="title">Nominal group technique consensus ratings for progesterone receptor testing</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK576822/table/chc.appn.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__chc.appn.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_chc.appn.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Area</th><th id="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Statement no.</th><th id="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Statement</th><th id="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Agreement (%)</th><th id="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Action</th></tr></thead><tbody><tr><td headers="hd_h_chc.appn.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Prognosis</td><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Positive progesterone receptor status is associated with favourable prognosis</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">80</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Used to inform recommendation</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tumours that are negative for progesterone receptors have a worse prognosis</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Used to inform recommendation</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_1" rowspan="6" colspan="1" style="text-align:left;vertical-align:top;">Endocrine therapy</td><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Positive progesterone receptor status predicts response to endocrine therapy in people with oestrogen receptor negative breast cancer</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Endocrine therapy should be offered to individuals whose tumour is oestrogen receptor negative, but progesterone receptor positive</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Positive progesterone receptor status is indicative of benefit from endocrine therapy</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tumours that are negative for progesterone receptors are less responsive to endocrine therapy</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Combined measurement of oestrogen receptor status and progesterone receptor status more accurately predicts benefit from adjuvant hormone treatment for invasive breast cancer than oestrogen receptor status alone</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Re-drafted and re-rated.</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status does not predict benefit of endocrine therapy in oestrogen receptor negative tumours</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Chemotherapy</td><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For breast cancer where the benefit of chemotherapy is borderline, it should be offered if individuals have progesterone receptor negative breast cancer</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Re-drafted and re-rated despite low agreement (<60%) due to committee comments</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor negative tumours should be considered high risk and, therefore, candidates for chemotherapy</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_1" rowspan="6" colspan="1" style="text-align:left;vertical-align:top;">Assessment of PR status</td><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status does not provide useful information in oestrogen receptor positive breast cancer</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status is relevant when making decisions regarding adjuvant therapy</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">82</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Used to inform recommendation</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status should be assessed in all newly diagnosed invasive breast cancers</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">82</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Used to inform recommendation</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status should be assessed in invasive breast cancer only if the results would influence treatment planning</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments used to inform recommendation</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status should be assessed only in selected cases (e.g., oestrogen receptor negative cancer, cases with borderline benefit of chemotherapy, assessing eligibility for clinical trials)</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments used to inform recommendation</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status of tumours in patients with invasive breast cancer should not be routinely assessed</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discarded as less than 60% agreement</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Re-rated statements</td><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 (round 2)</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Progesterone receptor status provides additional information to oestrogen receptor status that may be beneficial when considering the likely benefit of adjuvant hormone treatment for invasive breast cancer</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">90</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Used to inform recommendation</td></tr><tr><td headers="hd_h_chc.appn.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 (round 2)</td><td headers="hd_h_chc.appn.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Negative progesterone receptor status is one factor that may increase the benefit from chemotherapy and may increase the likelihood chemotherapy is offered in borderline cases</td><td headers="hd_h_chc.appn.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100</td><td headers="hd_h_chc.appn.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Used to inform recommendation</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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