Agreement: I AgreeBody: Dear Editor: The paper uses (pooled) C-statistic for assessing the performance of risk prediction models. This statistic is based on sensitivity and specificity, which are retrospective measures based on discrimination of the subjects known to be with and without disease. This almost ignores the prevalence. Prediction has future overtones and requires prospective setup where the subjects with and without risk factor are followed up for finding how many develop the disease and how many not. We have emphasized this aspect in our paper (ahead of print) [1] PPV-NPV based measure should be used in place of sensitivity-specificity based measure. Predictivity intimately depends on prevalence and could vary from situation to situation. This aspect is ignored by this and many other papers. 1 Indrayan, Abhaya; Mishra, Sakshi Assessing the Adequacy of a Prediction Model. Indian Journal of Community Medicine 50(5):p 739-744, Sep–Oct 2025. DOI: 10.4103/ijcm.ijcm_567_24 https://journals.lww.com/ijcm/fulltext/9900/assessing_the_adequacy_of_a_... No competing Interests: YesThe following competing Interests: Electronic Publication Date: Saturday, October 4, 2025 - 01:10AI use: No, I have not used AIHighwire Comment Subject: Risk prediction models for cancer therapy related cardiac dysfunction in patients with cancer and cancer survivors: systematic review and meta-analysisWorkflow State: ReleasedFull Title: Re: Risk prediction models for cancer therapy related cardiac dysfunction in patients with cancer and cancer survivors: systematic review and meta-analysis - C-statistic is a wrong index for prediction Highwire Comment Response to: Risk prediction models for cancer therapy related cardiac dysfunction in patients with cancer and cancer survivors: systematic review and meta-analysisCheck this box if you would like your letter to appear anonymously:: Last Name: IndrayanFirst name and middle initial: AbhayaEmail: a.indrayan@gmail.comAddress: NOIDAOccupation: ConsultancyAffiliation: Max HealthcareBMJ: Additional Article Info: Rapid response