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Prognosis Research Strategy (PROGRESS) 2: Prognostic Factor Research
Open accessAbstract
Prognostic factor research aims to identify factors associated with subsequent clinical outcome in people with a particular disease or health condition.In this article, the second in the PROGRESS series, the authors discuss the role of prognostic factors in current clinical practice, randomised trials, and developing new interventions, and explain why and how prognostic factor research should be improved.The Guidelines and Guidance section contains advice on conducting and reporting medical research.
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![Figure 1 Tumour grade as a prognostic factor in breast cancer. Kaplan-Meier curves for disease-free survival for three groups of breast cancer patients defined by tumour grade status (1, 2, or 3). Curves are derived from 246 breast cancer patients treated with tamoxifen who had 94 recurrences or deaths over a possible 7 years of follow-up (reproduced with published data relating to Schumacher et al [1]). The distinct curves, significant log rank result, and hazard ratio estimates suggests tumour grade is a prognostic factor, as it identifies three groups of patients with a different average prognosis.](/paper-figures/0d235379357046068c117f4c81d2cdb6/prognosis-research-strategy-progress-2-prognostic-factor-research-figure-1.jpg)
![Figure 2 Evaluation of whether homocysteine is a prognostic factor, and whether modifying it improves clinical outcome in patients with coronary disease (drawn from data in [35]). Path element adapted from Chart 7.1 in the Cooksey report (2006) http://bit.ly/Ro27rL (made available for use and re-use through the Open Government License).](/paper-figures/f22651a05c0b49db8bbde8bd6a31e883/prognosis-research-strategy-progress-2-prognostic-factor-research-figure-2.jpg)
![Figure 3 Discovery of prognostic factors: a genome-wide association study of survival among people with breast cancer, and replication in 15 studies (Mid-figure forest plot based on example plots in [4]. Path element adapted from Chart 7.1 in the Cooksey report (2006) http://bit.ly/Ro27rL (made available for use and re-use through the Open Government License).](/paper-figures/12da3f48cb59477b986b11319b011816/prognosis-research-strategy-progress-2-prognostic-factor-research-figure-3.jpg)
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“In both the diagnostic and prognostic setting, estimates of probabilities are rarely based on a single predictor [5].”
From Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement (2015) · cites this paper as [5]
In the citing paper
“In both the diagnostic and prognostic setting, estimates of probabilities are rarely based on a single predictor.5”
From Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD Statement (2015) · cites this paper as [5]
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Citations
Cites
Dichotomizing continuous predictors in multiple regression: a bad idea
Royston, P., Altman, D. G., & Sauerbrei, W. (2006) · Statistics in Medicine · doi:10.1002/sim.2331 · Cited by 2,312
Self-citationMeta-analysis of individual participant data: rationale, conduct, and reporting
Riley, R. D., Lambert, P. C., & Abo-Zaid, G. (2010) · BMJ · doi:10.1136/bmj.c221 · Cited by 1,701
Self-citationPrognosis Research Strategy (PROGRESS) 3: Prognostic Model Research
Steyerberg, E. W., Moons, K. G. M., van der Windt, D. A., Hayden, J. A., Perel, P., Schroter, S., Riley, R. D., Hemingway, H., Altman, D. G., & for the PROGRESS Group (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001381 · Cited by 1,508 · cited 1×
“Some prognostic models for predicting individual outcome risk are being used in clinical practice, such as the GRACE score in acute myocardial infarction or the ADJUVANT! score in breast and other cancers, and we consider them further in the third paper in our series [17].”
MethodSelf-citationEvaluation of the Quality of Prognosis Studies in Systematic Reviews
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Self-citationREporting recommendations for tumour MARKer prognostic studies (REMARK).
for the Statistics Subcommittee of the NCI-EORTC Working Group on Cancer Diagnostics, McShane, L. M., Altman, D. G., Sauerbrei, W., Taube, S. E., Gion, M., & Clark, G. M. (2005) · British Journal of Cancer · doi:10.1038/sj.bjc.6602678 · Cited by 1,394
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Hlatky, M. A., Greenland, P., Arnett, D. K., Ballantyne, C. M., Criqui, M. H., Elkind, M. S. V., Go, A. S., Harrell, F. E., Hong, Y., Howard, B. V., et al. (2009) · Circulation · doi:10.1161/circulationaha.109.192278 · Cited by 1,146
Dangers of Using "Optimal" Cutpoints in the Evaluation of Prognostic Factors
Altman, D. G., Lausen, B., Sauerbrei, W., & Schumacher, M. (1994) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/86.11.829 · Cited by 1,143
Self-citationSystematic reviews of evaluations of prognostic variables
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- 2008, NICE technology appraisal guidance 152: drug-eluting stents for the treatment of coronary artery disease (part review of NICE technology appraisal guidance 71), NICE
- 2010, NICE technology appraisal guidance 192: Gefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer, NICE
- RD Riley, 2007, Prognosis research: toward evidence-based results and a Cochrane methods group, J Clin Epidemiol, 60, 863
- KG Moons, 2010, Criteria for scientific evaluation of novel markers: a perspective, Clin Chem, 56, 537, 10.1373/clinchem.2009.134155 · DOI
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Hillman, S. (2014) · University of Birmingham Institutional Research Archive (University of Birmingham)
Metadata
- Authors
- Riley, R. D., Hayden, J. A., Steyerberg, E. W., Moons, K. G. M., Abrams, K., Kyzas, P. A., Malats, N., Briggs, A., Schroter, S., Altman, D. G., Hemingway, H., & for the PROGRESS Group
- Affiliations
- University of Birmingham (GB)
- Dalhousie University (CA)
- Erasmus MC (NL)
- University Medical Center Utrecht (NL)
- University of Leicester (GB)
- North Manchester General Hospital (GB)
- Spanish National Cancer Research Centre (ES)
- University of Glasgow (GB)
- BMJ Group (United Kingdom) (GB)
- University of Oxford (GB)
- University College London (GB)
- Corresponding author
- Riley, Richard D.
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-02-05
- Volume
- 10
- Issue
- 2
- Pages
- e1001380
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC3564757
- OpenAlex
- W2100741073
- Cited by
- 823
- References
- 71
- Citations by year
- 2026: 68 · 2025: 72 · 2024: 60 · 2023: 88 · 2022: 95 · 2021: 79 · 2020: 83 · 2019: 44 · 2018: 50 · 2017: 37 · 2016: 37 · 2015: 46 · 2014: 48 · 2013: 15
- FWCI
- 9.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (acceptedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- Queen Mary University of London
- National Institute for Social Care and Health Research
- London School of Hygiene and Tropical Medicine
- Wellcome Trust (086091, 086091/Z/08/Z)
- Nova Scotia Health Research Foundation
- Cancer Research UK (C5529)
- National Institute for Health and Care Research (NF-SI-0509-10183, NI-SI-0508-10061, RP-PG-0407-10314, NF-SI-0512-10159, RP-PG-0407-10386)
- British Heart Foundation
- University of Birmingham
- Dalhousie University
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (918.10.615)
- Center for Translational Molecular Medicine (03O-203)
- Versus Arthritis
- Canadian Institutes of Health Research
- Medical Research Council (G0800808, G0902393)
- Engineering and Physical Sciences Research Council
- Economic and Social Research Council
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Keywords
- prognostic factors, prognosis, clinical outcomes, research strategies, randomised trials, intervention development, research reporting, clinical practice
- MeSH terms
- Decision Support Techniques, Health Services Research, Humans, Predictive Value of Tests, Prognosis, Research Design, Risk Factors, Biomarkers, Randomized Controlled Trials as Topic, Treatment Outcome, Disease Progression, Risk Assessment, Biomedical Research
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