Nottingham Prognostic x (NPx): a risk stratification tool in ER-positive HER2-negative breast cancer: A validation study

Lashen, Ayat G; Toss, Michael; Miligy, Islam; Rewcastle, Emma; Kiraz, Umay; Janssen, Emiel A M; Green, Andrew R; Quinn, Cecily; Ellis, Ian; Rakha, Emad

Abstract

Aims
In this study, we validate the use of Nottingham Prognostic x (NPx), consisting of tumour size, tumour grade, progesterone receptor (PR) and Ki67 in luminal BC.

Materials and methods
Two large cohorts of luminal early-stage BC (n = 2864) were included. PR and Ki67 expression were assessed using full-face resection samples using immunohistochemistry. NPx was calculated and correlated with clinical variables and outcome, together with Oncotype DX recurrence score (RS), that is frequently used as a risk stratifier in luminal BC.

Results
In the whole cohort, 38% of patients were classified as high risk using NPx which showed significant association with parameters characteristics of aggressive tumour behaviour and shorter survival (P < 0.0001). NPx classified the moderate Nottingham Prognostic Index (NPI) risk group (n = 1812) into two distinct prognostic subgroups. Of the 82% low-risk group, only 3.8% developed events. Contrasting this, 14% of the high-risk patients developed events during follow-up. A strong association was observed between NPx and Oncotype Dx RS (P < 0.0001), where 66% of patients with intermediate risk RS who had subsequent distant metastases also had a high-risk NPx.

Conclusion
NPx is a reliable prognostic index in patients with luminal early-stage BC, and in selected patients may be used to guide adjuvant chemotherapy recommendations.

Citation

Lashen, A. G., Toss, M., Miligy, I., Rewcastle, E., Kiraz, U., Janssen, E. A. M., Green, A. R., Quinn, C., Ellis, I., & Rakha, E. (2024). Nottingham Prognostic x (NPx): a risk stratification tool in ER-positive HER2-negative breast cancer: A validation study. Histopathology, 85(3), 468-477. https://doi.org/10.1111/his.15234

• Journal Article Type: Article
• Acceptance Date: May 28, 2024
• Online Publication Date: Jun 13, 2024
• Publication Date: 2024-09
• Deposit Date: Aug 16, 2024
• Publicly Available Date: Aug 19, 2024
• Print ISSN: 0309-0167
• Electronic ISSN: 1365-2559
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 85
• Issue: 3
• Pages: 468-477
• DOI: https://doi.org/10.1111/his.15234
• Public URL: https://nottingham-repository.worktribe.com/output/38382506
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/his.15234