{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:04:39Z","timestamp":1792177479478,"version":"4.4.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"GEICAM Spanish Breast Cancer Group"},{"name":"GEICAM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Identifying high-risk of late recurrence (beyond 10 years) in patients with hormone receptor-positive HER2-negative early breast cancer (EBC) is crucial. The Clinical Treatment Score post-5 years (CTS5) score assesses recurrence risk after 5 years of endocrine therapy (ET). This study validated CTS5 as a prognostic tool for late recurrence by examining its association with Distant Recurrence-Free Survival using GEICAM study data and evaluating model calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 5739 hormone receptor-positive HER2-negative EBC patients from the El \u00c1lamo IV registry (N\u2005=\u20053509, diagnosed between 2002 and 2005) and 4 adjuvant GEICAM studies (N\u2005=\u20052680, conducted between 1996 and 2006). All patients were distant recurrence-free and alive 5 years after starting adjuvant ET.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The CTS5 classified 43.9% of patients as low-risk, 32.2% as intermediate-risk, and 23.9% as high-risk. Significant differences in DR were observed: hazard ratio (HR) for intermediate- vs. low-risk was 2.55 (95% CI, 1.85-3.51, P\u2005&amp;lt;\u2005.0001), and HR for high- vs. low-risk was 5.77 (95% CI, 4.28-7.78, P\u2005&amp;lt;\u2005.0001). Similar results were found across subgroups by menopausal status, duration of adjuvant ET, and prior adjuvant chemotherapy (CT). Calibration showed CTS5 overestimated DR rates in low-risk (P\u2005=\u2005.0314) and high-risk (P\u2005&amp;lt;\u2005.0001) patients compared to observed rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The CTS5 categorized patients based on late DR risk regardless of menopausal status, ET duration, or CT treatment. However, the model tended to overestimate events, particularly in high-risk groups, especially among those treated with ET for less than 60 months or not receiving CT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyaf040","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T15:24:40Z","timestamp":1739460280000},"source":"Crossref","is-referenced-by-count":3,"title":["Retrospective analysis to validate the CTS5 in patients from\n                    <i>El \u00c1lamo IV<\/i>\n                    registry and GEICAM adjuvant studies"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2606-9538","authenticated-orcid":false,"given":"Sara","family":"Lopez-Tarruella","sequence":"first","affiliation":[{"name":"Hospital Universitario Gregorio Mara\u00f1\u00f3n, Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IiSGM), Universidad Complutense , 28007 Madrid ,","place":["Spain"]},{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Oncolog\u00eda, CIBERONC-ISCIII ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Poll\u00e1n","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Oncolog\u00eda, CIBERONC-ISCIII ,","place":["Spain"]},{"name":"Centro Nacional de Epidemiolog\u00eda. 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,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Oncolog\u00eda, CIBERONC-ISCIII ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Servitja","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Hospital del Mar , 08003 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bego\u00f1a","family":"Bermejo","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Hospital Cl\u00ednico Universitario de Valencia, Biomedical Research Institute INCLIVA , 46010 Valencia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ant\u00f3n","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Hospital Universitario Miguel Servet, Instituto de Investigaci\u00f3n Sanitaria Arag\u00f3n (IISA), Universidad de Zaragoza , 50009 Zaragoza ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel","family":"Guerrero-Zotano","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Instituto Valenciano de Oncolog\u00eda , 46009 Valencia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Hospital Clinic i Provincial , 08036 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Consorcio Corporaci\u00f3n Sanitaria Parc Taul\u00ed , 08208 Sabadell ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purificaci\u00f3n","family":"Mart\u00ednez del Prado","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Hospital Universitario Basurto , 48013 Bilbao ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"\u00c1lvarez","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Hospital de Donostia , 20014 San Sebastian ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lourdes","family":"Calvo","sequence":"additional","affiliation":[{"name":"GEICAM, Spanish Breast Cancer Group , 28703 Madrid ,","place":["Spain"]},{"name":"Complejo Hospitalario Universitario de la Coru\u00f1a , 15006 A Coru\u00f1a 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