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Diagnostic Prediction Model for De Novo Metastatic Breast Cancer

10. august 2026 opdateret af: Oliver Laszlo Stari, Markusovszky University Teaching Hospital os County Vas

Development of a Diagnostic Prediction Model for de Novo Metastatic Breast Cancer Using Routinely Available Baseline Parameters

The goal of this observational study is to create a tool to estimate the risk of macroscopic distant tumor spread in women with newly diagnosed breast cancer. The main question it aims to answer is:

• Can a model, which combines routine medical information collected at diagnosis, accurately predict if a patient has metastasis large enough to be found during systemic imaging? Researchers will review the past medical records of participants who were treated at a university hospital. Because this study looks at past data, participants will not be asked to do any new tasks, take new tests, or change their medical care.

Studieoversigt

Status

Rekruttering

Betingelser

Detaljeret beskrivelse

BACKGROUND AND RATIONALE

Baseline risk assessment traditionally relies on anatomical extent, while intrinsic tumour aggressiveness is established as a key determinant of distant spread. In addition, the systemic inflammatory response is increasingly recognized as a driver of tumour progression. The evaluation of these diverse and often conflicting factors complicates early clinical decision-making.

OBJECTIVE

The objective of this study is to develop and internally validate a multivariable diagnostic prediction model using routinely available baseline parameters to estimate the individualised probability of macroscopic distant metastasis among patients with newly diagnosed invasive breast cancer.

STUDY DESIGN AND SETTING

This is an investigator-initiated, single-centre, retrospective cohort study adhering to the TRIPOD+AI statement. The study is conducted at a university teaching hospital, where comprehensive baseline systemic staging is the institutional standard for all newly diagnosed breast cancer patients.

PREDICTORS

The model integrates routinely available baseline parameters: clinical tumor size, clinical lymphnode status, the Ki-67 proliferation marker, and a composite systemic inflammatory marker (Pan-immune-inflammation value).

DATA COLLECTION AND QUALITY ASSURANCE

Data extraction is performed independently by two multidisciplinary teams. Any discrepancies are resolved through a formal adjudication process by an expert panel not involved in data collection (senior oncologist, radiologist, pathologist, and surgeon).

SAMPLE SIZE AND MISSING DATA Based on the criteria proposed by Riley et al., the study requires a minimum of 925 participants and 93 events to accommodate maximum model complexity. Missing data will be handled using complete-case analysis if the rate is <5%, or multiple imputation if >5%.

STATISTICAL ANALYSIS AND MODEL DEVELOPMENT

For the multivariable logistic regression model, all pre-specified predictors are entered simultaneously. Continuous variables are retained in their continuous form. Non-linear relationships modeled using restricted cubic splines. Model performance is evaluated via discrimination and calibration metrics, while clinical utility is assessed through decision curve analysis. Internal validation is conducted using bootstrapping. To correct for model optimism, a global shrinkage factor based on the bootstrap calibration slope is applied. Instability plots are used to illustrate the stability of predictions, calibration, and net benefit.

PATIENT AND PUBLIC INVOLVEMENT (PPI)

To initiate Patient and Public Involvement, an inaugural patient engagement event will be held to discuss the clinical acceptability of a diagnostic prediction model and its potential role in shared decision-making. This event will serve as the foundation to establish a voluntary Patient Advisory Group (PAG). In subsequent project stages, the newly formed PAG will collaborate to co-produce a Plain Language Summary and explore potential pathways for the tool's future clinical application.

Undersøgelsestype

Observationel

Tilmelding (Anslået)

925

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • Vas County
      • Szombathely, Vas County, Ungarn, 9700
        • Rekruttering
        • Markusovszky University Teaching Hospital
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

A consecutive cohort of adult female patients with newly diagnosed invasive breast cancer.

Beskrivelse

Inclusion Criteria:

  • Female sex, aged 18 years or older.
  • Newly diagnosed invasive breast cancer.
  • Case reviewed by the Multidisciplinary Tumour Board at the study site during the inclusion period (between October 1, 2018, and July 31, 2025).
  • No history of prior or synchronous invasive malignancies, except for synchronous bilateral breast cancer.
  • Intent for primary treatment and clinical management at the study site.
  • Availability of longitudinal clinical records throughout the 12-month follow-up period or until death.

Exclusion Criteria:

-Absence of baseline systemic staging.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Primary study cohort

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
De novo metastatic breast cancer
Tidsramme: From the initial diagnostic mammogram up to 12 months of follow-up.
A newly diagnosed breast cancer with distant spread identified at baseline systemic staging. Distant lesions are categorized as de novo metastasis if confirmed via biopsy, secondary imaging, follow-up imaging, or Multidisciplinary Tumor Board consensus based on definitive clinical evidence. Equivocal cases are adjudicated through a review of the 12 month clinical follow-up.
From the initial diagnostic mammogram up to 12 months of follow-up.

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of rapid metastatic recurrence
Tidsramme: Up to 12 months from the initial diagnostic mammogram.
Patients developing systemic spread within the 12-month follow-up period, subsequent to an initially negative baseline systemic staging. Patients with rapid metastatic recurrence are excluded from the multivariable analysis and reported descriptively.
Up to 12 months from the initial diagnostic mammogram.
Systemic staging interval
Tidsramme: Up to 12 months from the initial diagnostic mammogram.
The time elapsed from the initial diagnostic mammogram to the completion of baseline systemic staging.
Up to 12 months from the initial diagnostic mammogram.
Diagnostic interval
Tidsramme: Up to 12 months from the initial diagnostic mammogram.
The time elapsed from the initial diagnostic mammogram to the confirmation of macroscopic distant metastasis.
Up to 12 months from the initial diagnostic mammogram.

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

10. august 2026

Primær færdiggørelse (Anslået)

31. oktober 2026

Studieafslutning (Anslået)

28. februar 2027

Datoer for studieregistrering

Først indsendt

3. august 2026

Først indsendt, der opfyldte QC-kriterier

3. august 2026

Først opslået (Faktiske)

7. august 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

12. august 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

10. august 2026

Sidst verificeret

1. august 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • VAS-RKEB/BNJ-6/2026

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

JA

IPD-planbeskrivelse

A complete, cleaned, and de-identified copy of the final dataset will be shared. Sensitive data types, including digital images, specific event dates, and demographic details other than categorical age groups, will be redacted.

IPD-delingstidsramme

Data will become available upon the publication of the study results and will remain accessible in a restricted-access repository for a period of 5 years.

IPD-delingsadgangskriterier

Access will be granted to qualified researchers who submit a methodologically sound proposal for multicenter collaboration, external validation, further research, or independent verification of the results. Data access requests must be submitted through the repository's access management portal, and researchers will be required to sign a Data Use Agreement.

IPD-deling Understøttende informationstype

  • STUDY_PROTOCOL
  • SAP
  • ANALYTIC_CODE

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