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External validation is essential to assess model performance across populations and healthcare settings. We aimed to externally validate PREDICT using clinical practice data from the Netherlands, Sweden, and Slovenia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We validated PREDICT in national populations (\n                      <jats:italic>Netherlands, N<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>221,636; Sweden, N<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>84,928)<\/jats:italic>\n                      and in two specific subgroups: patients with invasive lobular breast cancer (ILC)\n                      <jats:italic>(Netherlands, N<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>26,834; Sweden, N<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>10,563; Slovenia, N<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>341)<\/jats:italic>\n                      and patients aged\u2009\u2264\u200940 years\n                      <jats:italic>(Netherlands, N<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>9995; Sweden, N<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>2694)<\/jats:italic>\n                      . We assessed discrimination with the 10-year area under the curve (AUC) and calibration of 10-year mortality predictions through calibration plots, intercepts and slopes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PREDICT v3.1 discriminated well in the national populations (Netherlands AUC 0.75, 95% CI 0.75\u20130.76; Sweden 0.75, 95% CI 0.75\u20130.76), with similar discrimination in ILC patients (Netherlands 0.76, 95% CI 0.74\u20130.76; Sweden 0.75, 95% CI 0.73\u20130.77; Slovenia 0.78, 95% CI 0.71\u20130.83). Calibration showed slight underestimation of mortality risk in the Netherlands (intercept 0.13; slope 1.01), and was near perfect in the Swedish population (intercept 0.04; slope 1.05). Amongst ILC patients, we observed some underestimation of mortality (Netherlands intercept 0.20; Sweden intercept 0.10; Slovenia intercept 0.02). In young patients, miscalibration was observed (Netherlands, intercept 0.21, slope 0.79; Sweden, intercept 0.08, slope 0.85).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PREDICT v3.1 is generally well calibrated and suitable for clinical use in the evaluated European populations. Efforts to improve PREDICT should focus on more accurate predictions for younger patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10549-026-07958-w","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T02:04:08Z","timestamp":1776391448000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["External validation of PREDICT Breast v3.1 for overall survival in international cohorts, including young and invasive lobular subgroups"],"prefix":"10.1007","volume":"217","author":[{"given":"Elfi M.","family":"Verheul","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Doornkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iurii","family":"Petrov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Siesling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hester F.","family":"Lingsma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linetta B.","family":"Koppert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara W. 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