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A P-value >0.1 was used as a criterion for exclusion, in accordance with the literature on multivariate prognostic modelling (Steyerberg et al., 2000).
In line with Harrell's recommendations on multivariate prognostic modelling, 19 20 no more than m/10 parameters were considered, where m is the number of uncensored events, in this case cardiovascular deaths (n = 37).
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Then, a multivariate prognostic model was constructed by incorporating all the five adverse prognostic factors.
This justifies the efforts to build multivariate prognostic models such as AdjuvantOnline (Adjuvant! Inc., San Antonio, TX, USA) and multigene predictors.
When both ER and PR protein expression were included in the same multivariate prognostic model, neither ER nor PR made an independent contribution to the prognostic model.
Whereas, this may not be sufficiently high to forego adjuvant chemotherapy, these observations pave the way to develop a clinically useful multivariate prognostic model for TNBC.
To further evaluate the clinical significance of ER and PR expression, we built multivariate prognostic models incorporating ER and PR protein expression and standard clinico-pathologic factors.
The development of a multivariate prognostic model is based on principles and methods described by Moons and Altman et al. [ 66- 69].
Efforts are under way to develop simple multivariate prognostic models that use routine pathological variables (such as ER, histologic grade and HER2 status), and these could eventually rival the performance of the first-generation prognostic gene signatures [ 20, 21].
2) Determine the association of PR expression with survival in ER+ and ER- breast cancer and assess the contribution of PR to multivariate prognostic models, including ER and standard clinico-pathologic factors.
When either ER or PR was included in multivariate prognostic models considering age, grade, tumor size (T) and nodal status (N), hormone receptor status was significantly associated with overall survival.
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