Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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External validation of IBTR! 2.0 nomogram for prediction of ipsilateral breast tumor recurrence

  • Lee, Byung Min (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Chang, Jee Suk (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Cho, Young Up (Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Park, Seho (Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Park, Hyung Seok (Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim, Jee Ye (Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Sohn, Joo Hyuk (Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim, Gun Min (Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Koo, Ja Seung (Department of Pathology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Keum, Ki Chang (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Suh, Chang-Ok (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim, Yong Bae (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • Received : 2018.02.08
  • Accepted : 2018.03.14
  • Published : 2018.06.30
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Abstract

Purpose: IBTR! 2.0 nomogram is web-based nomogram that predicts ipsilateral breast tumor recurrence (IBTR). We aimed to validate the IBTR! 2.0 using an external data set. Materials and Methods: The cohort consisted of 2,206 patients, who received breast conserving surgery and radiation therapy from 1992 to 2012 at our institution, where wide surgical excision is been routinely performed. Discrimination and calibration were used for assessing model performance. Patients with predicted 10-year IBTR risk based on an IBTR! 2.0 nomogram score of <3%, 3%-5%, 5%-10%, and >10% were assigned to groups 1, 2, 3, and 4, respectively. We also plotted calibration values to observe the actual IBTR rate against the nomogram-derived 10-year IBTR probabilities. Results: The median follow-up period was 73 months (range, 6 to 277 months). The area under the receiver operating characteristic curve was 0.607, showing poor accordance between the estimated and observed recurrence rate. Calibration plot confirmed that the IBTR! 2.0 nomogram predicted the 10-year IBTR risk higher than the observed IBTR rates in all groups. High discrepancies between nomogram IBTR predictions and observed IBTR rates were observed in overall risk groups. Compared with the original development dataset, our patients had fewer high grade tumors, less margin positivity, and less lymphovascular invasion, and more use of modern systemic therapies. Conclusions: IBTR! 2.0 nomogram seems to have the moderate discriminative ability with a tendency to over-estimating risk rate. Continued efforts are needed to ensure external applicability of published nomograms by validating the program using an external patient population.

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References

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