The prognostic performance of Adjuvant! Online and Nottingham Prognostic Index in young breast cancer patients

Background: Limited data are available on the prognostic performance of Adjuvant! Online (AOL) and Nottingham Prognostic Index (NPI) in young breast cancer patients. Methods: This multicentre hospital-based retrospective cohort study included young (p40 years) and older (55–60 years) breast cancer patients treated from January 2000 to December 2004 at four large Belgian and Italian institutions. Predicted 10-year overall survival (OS) and disease-free survival (DFS) using AOL and 10-year OS using NPI were calculated for every patient. Tools ability to predict outcomes (i.e., calibration) and their discriminatory accuracy was assessed. Results: The study included 1283 patients, 376 young and 907 older women. Adjuvant! Online accurately predicted 10-year OS (absolute difference: 0.7%; P¼0.37) in young cohort, but overestimated 10-year DFS by 7.7% (P¼0.003). In older cohort, AOL significantly underestimated both 10-year OS and DFS by 7.2% (Po0.001) and 3.2% (P¼0.04), respectively. Nottingham Prognostic Index significantly underestimated 10-year OS in both young (8.5%; Po0.001) and older (4.0%; Po0.001) cohorts. Adjuvant! Online and NPI had comparable discriminatory accuracy. Conclusions: In young breast cancer patients,