External validation of PREDICT Breast v3.1 for overall survival in international cohorts, including young and invasive lobular subgroups

PURPOSE: PREDICT Breast is an online tool that provides survival predictions for patients with early-stage breast cancer, for different treatments after surgery. External validation is essential to assess model performance across populations and healthcare settings. We aimed to externally validate PREDICT using clinical practice data from the Netherlands, Sweden, and Slovenia. METHODS: We validated PREDICT in national populations (Netherlands, N = 221,636; Sweden, N = 84,928) and in two specific subgroups: patients with invasive lobular breast cancer (ILC) (Netherlands, N = 26,834; Sweden, N = 10,563; Slovenia, N = 341) and patients aged ≤ 40 years (Netherlands, N = 9995; Sweden, N = 2694). We assessed discrimination with the 10-year area under the curve (AUC) and calibration of 10-year mortality predictions through calibration plots, intercepts and slopes. RESULTS: PREDICT v3.1 discriminated well in the national populations (Netherlands AUC 0.75, 95% CI 0.75-0.76; Sweden 0.75, 95% CI 0.75-0.76), with similar discrimination in ILC patients (Netherlands 0.76, 95% CI 0.74-0.76; Sweden 0.75, 95% CI 0.73-0.77; Slovenia 0.78, 95% CI 0.71-0.83). Calibration showed slight underestimation of mortality risk in the Netherlands (intercept 0.13; slope 1.01), and was near perfect in the Swedish population (intercept 0.04; slope 1.05). Amongst ILC patients, we observed some underestimation of mortality (Netherlands intercept 0.20; Sweden intercept 0.10; Slovenia intercept 0.02). In young patients, miscalibration was observed (Netherlands, intercept 0.21, slope 0.79; Sweden, intercept 0.08, slope 0.85). CONCLUSION: PREDICT v3.1 is generally well calibrated and suitable for clinical use in the evaluated European populations. Efforts to improve PREDICT should focus on more accurate predictions for younger patients.

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Journal
Breast Cancer Research and Treatment
Published
2026-04-17
DOI
https://doi.org/10.1007/s10549-026-07958-w
Primary Topic
Breast Cancer Treatment Studies
Type
article
Field-Weighted Citation Impact
0.00

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article

External validation of PREDICT Breast v3.1 for overall survival in international cohorts, including young and invasive lobular subgroups

Liesbeth C. de Wreede, Kathrina Dankl, Amara Callistus Nwosu, Dirk Snelders et al.
Breast Cancer Research and Treatment
Breast Cancer Treatment Studies
article

External validation of PREDICT Breast v3.1 for overall survival in international cohorts, including young and invasive lobular subgroups

Liesbeth C. de Wreede, Kathrina Dankl, Amara Callistus Nwosu, Dirk Snelders, Lára R. Hallsson, Teresa Puértolas, Narsis A. Kiani, Daisy Monika Lal, Michel W.J.M. Wouters, Iurii Petrov, Pimrapat Gebert, Carlos Romero-Piqueras, Claudia Cruz Oliveira, Frank Doornkamp, Lara W. A. Vreven, Tamara Wit, Toby Hackmann, Yassin Engelberts, Kasper Frank, Judith Rietjens, Hester F. Lingsma, Lennart Koch, Lea Doppelbauer, Linetta B. Koppert, Anne Stiggelbout, Adri C. Voogd, Simona Borstnar, Elfi M. Verheul, Elham Hedayati, Iñaki Álvarez Busto, Yufeng Liu, Ida Korfage, Sabine Siesling, Uwe Siebert, Maria Margarete Karsten, Ewout W. Steyerberg, Paul D. P. Pharoah, David van Klaveren
article en

Abstract

PURPOSE: PREDICT Breast is an online tool that provides survival predictions for patients with early-stage breast cancer, for different treatments after surgery. External validation is essential to assess model performance across populations and healthcare settings. We aimed to externally validate PREDICT using clinical practice data from the Netherlands, Sweden, and Slovenia. METHODS: We validated PREDICT in national populations (Netherlands, N = 221,636; Sweden, N = 84,928) and in two specific subgroups: patients with invasive lobular breast cancer (ILC) (Netherlands, N = 26,834; Sweden, N = 10,563; Slovenia, N = 341) and patients aged ≤ 40 years (Netherlands, N = 9995; Sweden, N = 2694). We assessed discrimination with the 10-year area under the curve (AUC) and calibration of 10-year mortality predictions through calibration plots, intercepts and slopes. RESULTS: PREDICT v3.1 discriminated well in the national populations (Netherlands AUC 0.75, 95% CI 0.75-0.76; Sweden 0.75, 95% CI 0.75-0.76), with similar discrimination in ILC patients (Netherlands 0.76, 95% CI 0.74-0.76; Sweden 0.75, 95% CI 0.73-0.77; Slovenia 0.78, 95% CI 0.71-0.83). Calibration showed slight underestimation of mortality risk in the Netherlands (intercept 0.13; slope 1.01), and was near perfect in the Swedish population (intercept 0.04; slope 1.05). Amongst ILC patients, we observed some underestimation of mortality (Netherlands intercept 0.20; Sweden intercept 0.10; Slovenia intercept 0.02). In young patients, miscalibration was observed (Netherlands, intercept 0.21, slope 0.79; Sweden, intercept 0.08, slope 0.85). CONCLUSION: PREDICT v3.1 is generally well calibrated and suitable for clinical use in the evaluated European populations. Efforts to improve PREDICT should focus on more accurate predictions for younger patients.

Breast Cancer Research and TreatmentVol. 217(2)
Cedars-Sinai Medical Center (US), Karolinska University Hospital (SE), Leiden University Medical Center (NL), Erasmus MC (NL), Karolinska Institutet (SE), University Medical Center Utrecht (NL), Institute of Oncology Ljubljana (SI), Maastricht University (NL), Zimmer Biomet (Germany) (DE), Dutch Institute for Clinical Auditing (NL), Karolinska Development (Sweden) (SE), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Netherlands Comprehensive Cancer Organisation (NL), Erasmus MC Cancer Institute (NL), Charité - Universitätsmedizin Berlin (DE), University of Twente (NL)
Harvard T.H. Chan School of Public Health, Universiteit Leiden, Technische Universiteit Delft, Leids Universitair Medisch Centrum, Universidad de Zaragoza, HORIZON EUROPE European Research Council
Gender equality
Openalex Percentile: Top 18%
Breast Cancer Treatment Studies
DOIOpen Access PDFOpenAlex
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