Nottingham Prognostic Index Plus: Validation of a clinical decision making tool in breast cancer in an independent series (original) (raw)
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Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer
British Journal of Cancer, 2014
Current management of breast cancer (BC) relies on risk stratification based on well-defined clinicopathologic factors. Global gene expression profiling studies have demonstrated that BC comprises distinct molecular classes with clinical relevance. In this study, we hypothesised that molecular features of BC are a key driver of tumour behaviour and when coupled with a novel and bespoke application of established clinicopathologic prognostic variables can predict both clinical outcome and relevant therapeutic options more accurately than existing methods. In the current study, a comprehensive panel of biomarkers with relevance to BC was applied to a large and well-characterised series of BC, using immunohistochemistry and different multivariate clustering techniques, to identify the key molecular classes. Subsequently, each class was further stratified using a set of well-defined prognostic clinicopathologic variables. These variables were combined in formulae to prognostically stratify different molecular classes, collectively known as the Nottingham Prognostic Index Plus (NPI+). The NPI+ was then used to predict outcome in the different molecular classes. Seven core molecular classes were identified using a selective panel of 10 biomarkers. Incorporation of clinicopathologic variables in a second-stage analysis resulted in identification of distinct prognostic groups within each molecular class (NPI+). Outcome analysis showed that using the bespoke NPI formulae for each biological BC class provides improved patient outcome stratification superior to the traditional NPI. This study provides proof-of-principle evidence for the use of NPI+ in supporting improved individualised clinical decision making.
Nottingham Prognostic Index: Useful tool to assess outcome inpatients of breast carcinoma
IP innovative publication pvt. ltd, 2020
Introduction: Breast cancer has been ranked number one cancer among the Indian females surpassing the incidence of cervical cancer. Multiple clinico-pathological-molecular prognostic factors are available in decision making about potentially suitable treatment options for breast cancer. Among all, Nottingham Prognostic Index (NPI) is the most powerful integrated index. Present study aimed to evaluate the significance of NPI in prognosis of operable breast cancer patients. Materials and Methods: This longitudinal (Descriptive) study was carried on 60 female patients of operable breast carcinoma at tertiary care centre in central India. Results: Two patients from good prognostic group (NPI3.4) (30%) had metastasis to bone & CNS. F rom moderate prognostic group ((NPI 3.4 - 5.4) (50%) , one patient had recurrence at previous surgical scar site and 3 patients had metastasis to liver, lung and supraclavicular lymph node each. However the worst outcome was found in patients from poor prognostic group (NPI > 5.4) (10%). Five patients from poor prognostic group had metastasis in liver, bone, CNS and lung with two patients had simultaneous metastasis in liver & bone. Four patients from poor prognostic group had death within two and half year s of primary diagnosis. Out of 60 patients, 34 patients had a follow up of more than 1000 days, so were included in statistical analysis of survival based on Cox Proportional Hazard Model. Among 7 variables, NPI was found to be statistically most significant with p value 0.001 Conclusion: Estimation of NPI is the powerful and reproducible index for assessing prognosis in patients with operable breast cancer in advanced resources deprived institute. Main strength of NPI lies in the fact that it is based on relatively simple data which can be provided in routine histopathology report of carcinoma breast.
Breast Cancer Research and Treatment, 1994
In primary, operable breast cancer, the Nottingham Prognostic Index (NPI) based on tumour size, lymphnode stage and histological grade can identify three prognostic groups (PGs) with 10-year survival rates of 83%, 52%, and 13%. With the aim of defining a subset of patients having so good prognosis that adjuvant therapy can be withhold, the NPI was applied to a Danish population-based study group comprising 9,149 patients. As opposed to the British study, we used conventional axillary lymph-node staging. Histological grading was in both studies done by means of a similar slight modification of the Bloom and Richardson procedure, but in the Danish study only ductal carcinomas were graded.
Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer
british journal of cancer, 2003
The Nottingham prognostic index (NPI), based on tumour size in breast, node involvement and Scarff-Bloom-Richardson (SBR) grading, has been shown to constitute a definitive prognostic factor of primary operable breast cancer in the adjuvant setting. We performed a retrospective study to evaluate the prognostic value of this index in 163 patients after neoadjuvant chemotherapy. Secondly, we examined the influence on survival of a revised NPI, only based on residual tumour size in breast and SBR grading in 228 patients, and consequently called breast grading index (BGI). The prognostic value of these two indices was also evaluated by replacing the SBR grade with the MSBR grade, a French modified SBR grading; the modified NPI (MNPI) and modified BGI (MBGI) were, respectively, obtained in 153 and 222 patients. At a median follow-up of 9.3 years, survival was significantly related to these four indices (Po0.001). Multivariate analysis revealed that MBGI was the only one which retained a prognostic influence on disease-free survival (Po0.02). In conclusion, the 'amount' of residual tumour in breast and/or nodes, as defined by NPI and revised indices, confers a determinant prognosis after neoadjuvant chemotherapy, inviting an alternative postsurgical treatment for a subgroup of patients with a decreased survival.
Breast Cancer Research, 2011
Breast Cancer Index (BCI) combines two independent biomarkers, HOXB13:IL17BR (H:I) and the 5-gene molecular grade index (MGI), that assess estrogen-mediated signalling and tumor grade, respectively. BCI stratifies early-stage estrogen-receptor positive (ER+), lymph-node negative (LN-) breast cancer patients into three risk groups and provides a continuous assessment of individual risk of distant recurrence. Objectives of the current study were to validate BCI in a clinical case series and to compare the prognostic utility of BCI and Adjuvant!Online (AO). Tumor samples from 265 ER+LN- tamoxifen-treated patients were identified from a single academic institution's cancer research registry. The BCI assay was performed and scores were assigned based on a pre-determined risk model. Risk was assessed by BCI and AO and correlated to clinical outcomes in the patient cohort. BCI was a significant predictor of outcome in a cohort of 265 ER+LN- patients (median age: 56-y; median follow-up: 10.3-y), treated with adjuvant tamoxifen alone or tamoxifen with chemotherapy (32%). BCI categorized 55%, 21%, and 24% of patients as low, intermediate and high-risk, respectively. The 10-year rates of distant recurrence were 6.6%, 12.1% and 31.9% and of breast cancer-specific mortality were 3.8%, 3.6% and 22.1% in low, intermediate, and high-risk groups, respectively. In a multivariate analysis including clinicopathological factors, BCI was a significant predictor of distant recurrence (HR for 5-unit increase = 5.32 [CI 2.18-13.01; P = 0.0002]) and breast cancer-specific mortality (HR for a 5-unit increase = 9.60 [CI 3.20-28.80; P < 0.0001]). AO was significantly associated with risk of recurrence. In a separate multivariate analysis, both BCI and AO were significantly predictive of outcome. In a time-dependent (10-y) ROC curve accuracy analysis of recurrence risk, the addition of BCI+AO increased predictive accuracy in all patients from 66% (AO only) to 76% (AO+BCI) and in tamoxifen-only treated patients from 65% to 81%. This study validates the prognostic performance of BCI in ER+LN- patients. In this characteristically low-risk cohort, BCI classified high versus low-risk groups with ~5-fold difference in 10-year risk of distant recurrence and breast cancer-specific death. BCI and AO are independent predictors with BCI having additive utility beyond standard of care parameters that are encompassed in AO.
Nottingham Prognostic Index in Triple-Negative Breast Cancer: a reliable prognostic tool?
BMC Cancer, 2011
Background A breast cancer prognostic tool should ideally be applicable to all types of invasive breast lesions. A number of studies have shown histopathological grade to be an independent prognostic factor in breast cancer, adding prognostic power to nodal stage and tumour size. The Nottingham Prognostic Index has been shown to accurately predict patient outcome in stratified groups with a follow-up period of 15 years after primary diagnosis of breast cancer. Clinically, breast tumours that lack the expression of Oestrogen Receptor, Progesterone Receptor and Human Epidermal growth factor Receptor 2 (HER2) are identified as presenting a "triple-negative" phenotype or as triple-negative breast cancers. These poor outcome tumours represent an easily recognisable prognostic group of breast cancer with aggressive behaviour that currently lack the benefit of available systemic therapy. There are conflicting results on the prevalence of lymph node metastasis at the time of diagn...
Short-Term Prognostic Index for Breast Cancer: NPI or Lpi
Pathology research international, 2010
Axillary lymph node involvement is an important prognostic factor for breast cancer survival but is confounded by the number of nodes examined. We compare the performance of the log odds prognostic index (Lpi), using a ratio of the positive versus negative lymph nodes, with the Nottingham Prognostic Index (NPI) for short-term breast cancer specific disease free survival. A total of 1818 operable breast cancer patients treated in the University Hospital of Leuven between 2000 and 2005 were included. The performance of the NPI and Lpi were compared on two levels: calibration and discrimination. The latter was evaluated using the concordance index (cindex), the number of patients in the extreme groups, and difference in event rates between these. The NPI had a significant higher cindex, but a significant lower percentage of patients in the extreme risk groups. After updating both indices, no significant differences between NPI and Lpi were noted.
Background: The Nottingham prognostic index (NPI) is a widely used clinic-pathological staging system for breast cancer prognostication. It is based on tumor size in breast, node involvement and histopathological grading. Objectives: To evaluate and determine the prognostic usefulness of this index and its components in our local patients. Patients and methods: In an observational retrospective study from January 2010 to January 2012, 85 patients with breast cancer with their information retrieved from patient records were evaluated at Omdurman Teaching Hospital. In these patients, we evaluated the significance of the following factors age, stage at diagnosis, histopathological grade, and number of axillary lymph nodes retrieved and involved. The Nottingham Prognostic Index was calculated. Results: Mean age ± SD was 46.5± 13.7 years, 45.9% were in the age group 31-45 years. Grade II breast cancer was seen in 58.7% of the specimen. Metastatic lymph nodes involvement accounted for 94.5% of the axillary tissues. Mean tumor size was 5.5 ± 3.9 cm. Mean Nottingham prognostic index was 5.3 ± 1.45 and 48.0% had a poor index (scored >5.4).Conclusion: Patients with breast cancer still present late with advanced disease. The NPI allows us to accurately predict prognosis, and we advocate its standardized use in our local practice.
Prognostication of breast cancer using Nottingham Prognostic Index in Sudanese patients
2014
Background: The Nottingham prognostic index (NPI) is a widely used clinic-pathological staging system for breast cancer prognostication. It is based on tumor size in breast, node involvement and histopathological grading. Objectives: To evaluate and determine the prognostic usefulness of this index and its components in our local patients. Patients and methods: In an observational retrospective study from January 2010 to January 2012, 85 patients with breast cancer with their information retrieved from patient records were evaluated at Omdurman Teaching Hospital. In these patients, we evaluated the significance of the following factors age, stage at diagnosis, histopathological grade, and number of axillary lymph nodes retrieved and involved. The Nottingham Prognostic Index was calculated. Results: Mean age ± SD was 46.5± 13.7 years, 45.9% were in the age group 31-45 years. Grade II breast cancer was seen in 58.7% of the specimen. Metastatic lymph nodes involvement accounted for 94.5% of the axillary tissues. Mean tumor size was 5.5 ± 3.9 cm. Mean Nottingham prognostic index was 5.3 ± 1.45 and 48.0% had a poor index (scored >5.4).Conclusion: Patients with breast cancer still present late with advanced disease. The NPI allows us to accurately predict prognosis, and we advocate its standardized use in our local practice.
Annals of Oncology, 2014
Background: The prognosis of metastatic breast cancer (MBC) is extremely heterogeneous. Although patients with MBC will uniformly die to their disease, survival may range from a few months to several years. This underscores the importance of defining prognostic factors to develop risk-adopted treatment strategies. Our aim has been to use simple measures to judge a patient's prognosis when metastatic disease is diagnosed. Patients and methods: We retrospectively analyzed 2269 patients from four clinical cancer registries. The prognostic score was calculated from the regression coefficients found in the Cox regression analysis. Based on the score, patients were classified into high-, intermediate-, and low-risk groups. Bootstrapping and time-dependent receiver operating characteristic curves were used for internal validation. Two independent datasets were used for external validation. Results: Metastatic-free interval, localization of metastases, and hormone receptor status were identified as significant prognostic factors in the multivariate analysis. The three prognostic groups showed highly significant differences regarding overall survival from the time of metastasis [intermediate compared with low risk: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.36-2.27, P < 0.001; high compared with low risk: HR 3.54, 95% CI 2.81-4.45, P < 0.001). The median overall survival in these three groups were 61, 38, and 22 months, respectively. The external validation showed congruent results. Conclusions: We developed a prognostic score, based on routine parameters easily accessible in daily clinical care. Although major progress has been made, the optimal therapeutic management of the individual patient is still unknown. Besides elaborative molecular classification of tumors, simple clinical measures such as our model may be helpful to further individualize optimal breast cancer care.