A retrospective validation of CanAssist Breast in European early-stage breast cancer patient cohort

Gunda, Aparna; Basavaraj, Chetana; Serkad, Chandra Prakash V; Adinarayan, Manjula; Kolli, Ramu; Eshwaraiah, Mallikarjuna Siraganahalli; Saura, Cristina; Ruiz-Pace, Fiorella; Gómez, Patricia; Peg, Vicente; Jimenez, José; Sprung, Susanne; Fiegl, Heidi; Brunner, Christine; Egle, Daniel; Bhattacharyya, G.S.; Bakre, Manjiri M.

doi:10.1016/j.breast.2022.02.010

Cited by 6 publications

(22 citation statements)

References 30 publications

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“…However, even in these divergent cohorts, with respect to clinical parameters, CAB risk proportions across these three cohorts, did not vary to the extent as observed with NPI/PREDICT. We have previously shown that CAB’s accuracy in predicting distant recurrence in the European cohort is similar to that of the Indian cohort [ 18 ]. This is because CAB assesses the risk of recurrence by assessing the expression of the proteins (CD44, ABCC4, ABCC11, N-Cadherin, pan-Cadherin) involved in critical signaling pathways involved in the invasion of blood vessels by tumor cells leading to the spread, and drug resistance pathways; other than hormone signaling (ER, PR, and associated genes) and cell division/cell death (MDM2, MELK, PTTG1, etc.…”

Section: Discussionmentioning

confidence: 92%

“…This high correlation observed between risk proportions and clinical parameters for NPI/PREDICT was not seen with CAB, although one could see a moderate decrease (T1-84%, T2-64%) in low-risk patients with an increase in clinical risk from T1 to T2 and similarly in node-positive versus node-negative tumors. This performance of CAB with minimal influence by clinical parameters is because CAB gives more importance to tumor biology than clinicopathological factors for recurrence risk prediction [ 16 – 18 ]. Moreover, in the European and USA cohorts dominated by patients with clinically low-risk features (T1/N0 tumors) NPI and PREDICT low-risk patients were tremendously high.…”

Section: Discussionmentioning

confidence: 99%

“…Concordance in the low-risk groups between two prognostic tests boosts the confidence of the clinician in avoiding chemotherapy. CAB has a very good concordance with multi-gene prognostic tests with 83% of concordance between CAB and Oncotype DX and MammaPrint in the low-risk category [ 18 , 28 ]. Here in the current report, it is notable to observe 97% concordance between CAB and NPI low-risk categories where the NPI low-risk proportions were just half of the CAB low-risk proportions.…”

Section: Discussionmentioning

confidence: 99%

“…Primary surgical blocks of FFPE tumor specimens from these patients along with patient age, clinical parameters, and treatment follow-up details were obtained from the respective treating hospital or biorepository. These samples were part of the earlier CAB validation studies [ 16 – 18 ]. The samples were obtained with the IRB and ethics committee approvals of all the participating hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…CAB segregates patients into two actionable risk groups, i.e., 'low or high' risk for cancer recurrence. CAB has been validated on more than 3500 patients across India, USA, and Europe and has been used prospectively in ~ 3000 patients to date to plan treatment since its launch [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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A comparative analysis of recurrence risk predictions in ER+/HER2− early breast cancer using NHS Nottingham Prognostic Index, PREDICT, and CanAssist Breast

Gunda¹,

Eshwaraiah²,

Gangappa³

et al. 2022

Breast Cancer Res Treat

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Aims Clinicians use multi-gene/biomarker prognostic tests and free online tools to optimize treatment in early ER+/HER2− breast cancer. Here we report the comparison of recurrence risk predictions by CanAssist Breast (CAB), Nottingham Prognostic Index (NPI), and PREDICT along with the differences in the performance of these tests across Indian and European cohorts. Methods Current study used a retrospective cohort of 1474 patients from Europe, India, and USA. NPI risk groups were categorized into three prognostic groups, good (GPG-NPI index ≤ 3.4) moderate (MPG 3.41–5.4), and poor (PPG > 5.4). Patients with chemotherapy benefit of < 2% were low-risk and ≥ 2% high-risk by PREDICT. We assessed the agreement between the CAB and NPI/PREDICT risk groups by kappa coefficient. Results Risk proportions generated by all tools were: CAB low:high 74:26; NPI good:moderate:poor prognostic group- 38:55:7; PREDICT low:high 63:37. Overall, there was a fair agreement between CAB and NPI[κ = 0.31(0.278–0.346)]/PREDICT [κ = 0.398 (0.35–0.446)], with a concordance of 97%/88% between CAB and NPI/PREDICT low-risk categories. 65% of NPI-MPG patients were called low-risk by CAB. From PREDICT high-risk patients CAB segregated 51% as low-risk, thus preventing over-treatment in these patients. In cohorts (European) with a higher number of T1N0 patients, NPI/PREDICT segregated more as LR compared to CAB, suggesting that T1N0 patients with aggressive biology are missed out by online tools but not by the CAB. Conclusion Data shows the use of CAB in early breast cancer overall and specifically in NPI-MPG and PREDICT high-risk patients for making accurate decisions on chemotherapy use. CAB provided unbiased risk stratification across cohorts of various geographies with minimal impact by clinical parameters.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A comparative analysis of recurrence risk predictions in ER+/HER2− early breast cancer using NHS Nottingham Prognostic Index, PREDICT, and CanAssist Breast

Gunda¹,

Eshwaraiah²,

Gangappa³

et al. 2022

Breast Cancer Res Treat

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The usefulness of CanAssist Breast over Ki67 in breast cancer recurrence risk assessment

Eshwaraiah¹,

Gunda²,

Kanakasetty

et al. 2023

Cancer Medicine

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Background: Assessment of Ki67 by immunohistochemistry (IHC) has limited utility in clinical practice owing to analytical validity issues. According to International Ki67 Working Group (IKWG) guidelines, treatment should be guided by a prognostic test in patients expressing intermediate Ki67 range, >5%-<30%. The objective of the study is to compare the prognostic performance of CanAssist Breast (CAB) with that of Ki67 across various Ki67 prognostic groups. Methods:The cohort had 1701 patients. Various risk groups were compared for the distant relapse-free interval (DRFi) derived from Kaplan-Meier survival analysis. As per IKWG, patients are categorized into three risk groups: low-risk (<5%), intermediate risk (>5%-<30%), and high-risk (>30%). CAB generates two risk groups, low and high risk based on a predefined cutoff.Results: In the total cohort, 76% of the patients were low risk (LR) by CAB as against 46% by Ki67 with a similar DRFi of 94%. In the node-negative sub-cohort, 87% were LR by CAB with a DRFi of 97% against 49% by Ki67 with a DRFi of 96%.In subgroups of patients with T1 or N1 or G2 tumors, Ki67-based risk stratification was not significant while it was significant by CAB. In the intermediate Ki67 (>5%-<30%) category up to 89% (N0 sub-cohort) were LR by CAB and the percentage of LR patients was 25% (p < 0.0001) higher compared to NPI or mAOL. In the low Ki67 (≤5%) group, up to 19% were segregated as high-risk by CAB with 86% DRFi suggesting the requirement of chemotherapy in these low Ki67 patients. Conclusion:CAB provided superior prognostic information in various Ki67 subgroups, especially in the intermediate Ki67 group.

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Risk Stratification of Early Breast Cancer (HR +/HER 2–) by CanAssist Breast and Its Corelation with Other Online Prognostic Tools: Experience from a Single Center

Bapna,

Patni,

Patni

et al. 2023

Indian J Med Paediatr Oncol

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Introduction Risk assessment by various methods for HR +/HER2– early-stage breast cancer (EBC) patients help clinicians stratify risk and tailor individual treatment. Multiple prognostic tests are available, both free and expensive. Free prognostic tools, the Nottingham Prognostic Index (NPI), and modified Adjuvant Online (mAOL) rely on clinical parameters. CanAssist Breast (CAB) considers both clinical parameters and tumor biology for assessing the risk of recurrence. Objectives The objective is to assess risk by CAB, NPI, and mAOL and discern the differences in the risk stratification in the EBC cohort of Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India. Methods Study cohort comprises 100 patients. Risk concordance was assessed by the kappa correlation coefficient and restratification analysis between risk groups of CAB, NPI, and mAOL was assessed using a two-sided p-value. Results Cohort was predominated by patients aged above 50, with T2/N0/G2 tumors. Low-risk (LR) and high-risk (HR) proportions by CAB, NPI, and mAOL were 67:33, 19:81, and 14:86, respectively. Across both age groups, CAB stratified more patients as LR compared with NPI and mAOL. In subgroups of patients with N0, G2, and T2 tumors, CAB identified significantly (p < 0.0001) higher (3–8 times) patients as LR than NPI and mAOL. In patients with T1/G1 tumors, risk proportions were similar by all three tools. Interestingly, CAB LR (57%) was four times that of NPI (14%) in the N1 subgroup. In G3 tumors CAB LR was 13%. mAOL failed to identify LR in the N1 and G3 subgroups and NPI in the G3 subgroup. There was poor agreement between CAB and NPI/mAOL (k 0.14 [95% confidence interval: 0.03–0.24]/0.11 [0.02–0.20]). Up to 11% of mAOL/NPI LR were detected as HR by CAB and up to 63% of mAOL and NPI HR as LR by CAB. Conclusion Prognostication by tools that use clinical parameters alone might be inadequate. Prognostication using CAB that integrates critical biomarkers indicative of tumor biology along with clinical parameters could be significant. The earlier published data on CAB across various ethnic cohorts and its comparable performance with Oncotype DX makes CAB a relevant prognostic test in HR +/HER2– EBC to make decisions on chemotherapy use.

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A retrospective validation of CanAssist Breast in European early-stage breast cancer patient cohort

Cited by 6 publications

References 30 publications

A comparative analysis of recurrence risk predictions in ER+/HER2− early breast cancer using NHS Nottingham Prognostic Index, PREDICT, and CanAssist Breast

A comparative analysis of recurrence risk predictions in ER+/HER2− early breast cancer using NHS Nottingham Prognostic Index, PREDICT, and CanAssist Breast

The usefulness of CanAssist Breast over Ki67 in breast cancer recurrence risk assessment

Risk Stratification of Early Breast Cancer (HR +/HER 2–) by CanAssist Breast and Its Corelation with Other Online Prognostic Tools: Experience from a Single Center

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