Evidence map›Paper›PMID 42372582›Full record

ArticleBreast (Edinburgh, Scotland)2026

Added value of the tumor-stroma ratio to the PREDICT model for breast cancer.

Sophie C Hagenaars, Tom A Hueting, Frederike Dieleman, Judith R Kroep, Ewout W Steyerberg, Emad A Rakha, Rob A E M Tollenaar, Hein Putter, Andrew R Green, Wilma E Mesker

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Breast (Edinburgh, Scotland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Sophie C HagenaarsDepartment of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Tom A HuetingEvidencio, Medical Decision Support, Haaksbergen, the Netherlands.
Frederike DielemanDepartment of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Judith R KroepDepartment of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Ewout W SteyerbergDepartment of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
Emad A RakhaNottingham Breast Cancer Research Centre, Academic Unit for Translational Medical Sciences, School of Medicine, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom.
Rob A E M TollenaarDepartment of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Hein PutterDepartment of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
Andrew R GreenNottingham Breast Cancer Research Centre, Academic Unit for Translational Medical Sciences, School of Medicine, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom.
Wilma E MeskerDepartment of Surgery, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: w.e.mesker@lumc.nl.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe tumor-stroma ratio (TSR) has repeatedly proven to be a strong prognostic and predictive marker in breast cancer. However, clinical integration of the TSR to further improve patient selection for breast cancer treatment and clinical decision making remains to be defined. Therefore, we evaluated the added value of the TSR to the well-recognized PREDICT model for survival outcomes following adjuvant systemic therapy.

methodsIn total, 1770 patients from the Nottingham Breast Cancer Series were included. The incremental value of the TSR following addition to the PREDICT model regarding change in overall prediction model performance was evaluated based on Cox regression analyses and the area under the curve (AUC) for 5-, 10- and 15-year overall survival. Analyses were reported for the total patient group and stratified by molecular subgroups.

resultsThe largest model performance improvement was observed in the triple-negative breast cancer (TNBC) subgroup. At 5 years, the AUC ameliorated from 63.9 (95% confidence interval 55.1-72.7) to 70.9 (63.4-78.3) (p = 0.05) with a hazard ratio (HR) of 2.58 (1.39-4.79, p = 0.003). For 10-year survival, the HR was 2.02 (1.21-3.39, p = 0.007), with a rise in the AUC from 64.0 (55.6-72.3) to 69.0 (61.3-76.6) (p = 0.1). At 15 years after clinical diagnosis, the AUC increased from 64.6 (54.0-75.2) to 71.6 (61.1-82.1) at borderline significance (p = 0.06), together with an HR of 2.02 (1.24-3.27, p = 0.005).

conclusionThe AUC improved for the total patient cohort and all subgroups following the addition of the TSR, although the strongest and most significant model enhancements were observed in the TNBC subgroup.

Indexed as

Breast NeoplasmsStromal CellsTriple Negative Breast NeoplasmsAdultAgedArea Under CurveChemotherapy, AdjuvantFemaleHumansMiddle AgedPredictive Value of TestsPrognosisProportional Hazards ModelsBreast cancerHistologyPrediction modelPrognosisTumor-stroma ratio

Identifiers

PMID42372582
PMCPMC13333366

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.