Dynamic prediction in XXXX : proving feasibility in clinical practice using the TEAM trial.

@entity1 @entity0 @entity1722 @entity5282 @entity1349
BACKGROUND: Predictive models are an integral part of current clinical practice and help determine optimal treatment strategies for individual @entity1 . A drawback is that covariates are assumed to have constant effects on @entity1349 ( @entity1349 ), when in fact, these effects may change during follow-up (FU). Furthermore, @entity0 ( @entity0 ) @entity1 may experience events that alter their prognosis from that time onwards. We investigated the 'dynamic' effects of different covariates on @entity1349 and developed a nomogram to calculate 5-year dynamic @entity1349 (DOS) probability at different prediction timepoints (tP) during FU. METHODS: Dutch and Belgian postmenopausal, endocrine-sensitive, early @entity0 @entity1 enrolled in the TEAM trial were included. We assessed time-varying effects of specific covariates and obtained 5-year DOS predictions using a proportional baselines landmark supermodel. Covariates included age, histological grade, @entity5282 and @entity1722 status, T- and N-stage, locoregional recurrence (LRR), distant recurrence, and treatment compliance. A nomogram was designed to calculate 5-year DOS based on individual characteristics. RESULTS: A total of 2602 @entity1 were included (mean FU 6.2 years). N-stage, LRR, and @entity1722 status demonstrated time-varying effects on 5-year DOS. Hazard ratio (HR) functions for LRR, high-risk N-stage (N2/3), and @entity1722 positivity were HR = (8.427 * 0.583[Formula: see text], HR = (3.621 * 0.816[Formula: see text], and HR = (1.235 * 0.851[Formula: see text], respectively. Treatment discontinuation was associated with a higher mortality risk, but without a time-varying effect [HR 1.263 (0.867-1.841)]. All other covariates were time-constant. DISCUSSION: The current nomogram accounts for elapsed time since starting adjuvant endocrine treatment and optimizes prediction of individual 5-year DOS during FU for postmenopausal, endocrine-sensitive @entity0 @entity1 . The nomogram can facilitate in determining whether further therapy will benefit an individual @entity1 , although validation in an independent dataset is still needed.
