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As v3.0 was recently released, we performed an external validation of PREDICT v2.2 and v3.0 in young (\u2264\u200940 years) breast cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included Swedish non-metastatic breast cancer patients aged \u2264\u200940 years, diagnosed between 2008\u20132019, from a registry-based research database. Outcomes were all-cause and breast cancer-specific mortality (BCSM) at 5- and 10-years, in all and in prespecified patient subgroups (by molecular subtype and nodal status). Model calibration and discrimination were evaluated by the integrated calibration index (ICI) and time dependant area under the receiver operator curve (tdAUC), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 3015 patients were included. PREDICT v2.2 consistently overestimated both all-cause mortality and BCSM at 5- (ICI\n                      <jats:sub>all-cause mortality<\/jats:sub>\n                      \u2009=\u20095.10%, 95% confidence interval (CI) 4.93\u20135.27; ICI\n                      <jats:sub>BCSM<\/jats:sub>\n                      \u2009=\u20094.91%, 95% CI 4.71\u20135.13) and 10- years (ICI\n                      <jats:sub>all-cause mortality<\/jats:sub>\n                      \u2009=\u20099.75%, 95% CI 9.02%\u201310.5, ICI\n                      <jats:sub>BCSM<\/jats:sub>\n                      \u2009=\u20099.71%, 95% CI 8.88\u201310.4). In contrast, PREDICT v3.0 showed much better calibration (5\u00a0years; ICI\n                      <jats:sub>all-cause mortality<\/jats:sub>\n                      \u2009=\u20090.69%, 95% CI 0.60\u20130.78; ICI\n                      <jats:sub>BCSM<\/jats:sub>\n                      \u2009=\u20090.65%, 95% CI 0.57\u2013 0.73; 10\u00a0years; ICI\n                      <jats:sub>all-cause mortality<\/jats:sub>\n                      \u2009=\u20095.10%, 95% CI 4.65\u20135.5%; ICI\n                      <jats:sub>BCSM<\/jats:sub>\n                      \u2009=\u20094.76%, 95% CI 4.31\u20135.19), although miscalibration remained in high-risk groups. Discrimination was excellent for predicting 5-year outcomes in both models but declined for 10-year predictions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PREDICT showed good discrimination in young patients. Although version 3.0 showed better calibration than v2.2, risk overestimation in high-risk patients may affect treatment decision-making and warrants cautious interpretation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13058-026-02271-2","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T21:34:48Z","timestamp":1774992888000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["PREDICT v3.0 outperforms v2.2 in young (25\u201340\u00a0years) breast cancer patients according to real-world data from a large Swedish population-based registry"],"prefix":"10.1186","volume":"28","author":[{"given":"Christine","family":"Lundgren","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irma","family":"Frediksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Valachis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Robert","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"2271_CR1","unstructured":"Nationellt kvalitetsregister f\u00f6r br\u00f6stcancer (NKBC). 2024. https:\/\/statistik.incanet.se\/brostcancer\/. 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An amendment for utilizing BCBaSe 3.0 to validate PREDICT was approved by the Swedish Ethical Review Authority at 20th April 2024 (reference number: 2024\u201301947-02). As BCBaSe is a registry-based data source, the Swedish Ethical Review Authority waived the need for informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"CL has received financial scholarship from Pfizer but is not in conflict of this project. IF has received institutional research grants from MSD, unrelated to the current work. AV has received institutional research grant from Roche and MSD, unrelated to the current work. DS declares no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"70"}}