Nottingham prognostic index plus (NPI+) predicts risk of distant metastases in primary breast cancer

Green, Andrew R.; Soria, Daniele; Powe, Desmond G.; Nolan, Christopher C.; Aleskandarany, Mohammed A.; Sz�sz, M.A.; T?k�s, A.M.; Ball, G.R.; Garibaldi, Jonathan M.; Rakha, Emad; Kulka, J.; Ellis, Ian O.

Abstract

The Nottingham prognostic index plus (NPI+) is based on the assessment of biological class combined with established clinicopathologic prognostic variables providing improved patient outcome stratification for breast cancer superior to the traditional NPI. This study aimed to determine prognostic capability of the NPI+ in predicting risk of development of distant disease. A well-characterised series of 1073 primary early-stage BC cases treated in Nottingham and 251 cases from Budapest were immunohistochemically assessed for cytokeratin (Ck)5/6, Ck18, EGFR, oestrogen receptor (ER), progesterone receptor, HER2, HER3, HER4, Mucin 1 and p53 expression. NPI+ biological class and prognostic scores were assigned using individual algorithms for each biological class incorporating clinicopathologic parameters and investigated in terms of prediction of distant metastases-free survival (MFS). The NPI+ identified distinct prognostic groups (PG) within each molecular class which were predictive of MFS providing improved patient outcome stratification superior to the traditional NPI. NPI+ PGs, between series, were comparable in predicting patient outcome between series in luminal A, basal p53 altered and HER2+/ER+ (p > 0.01) tumours. The low-risk groups were similarly validated in luminal B, luminal N, basal p53 normal tumours (p > 0.01). Due to small patient numbers the remaining PGs could not be validated. NPI+ was additionally able to predict a higher risk of metastases at certain distant sites. This study may indicate the NPI+ as a useful tool in predicting the risk of metastases. The NPI+ provides accurate risk stratification allowing improved individualised clinical decision making for breast cancer.

Citation

Green, A. R., Soria, D., Powe, D. G., Nolan, C. C., Aleskandarany, M. A., Szász, M., …Ellis, I. O. (2016). Nottingham prognostic index plus (NPI+) predicts risk of distant metastases in primary breast cancer. Breast Cancer Research and Treatment, 157(1), 65-75. https://doi.org/10.1007/s10549-016-3804-1

• Journal Article Type: Article
• Acceptance Date: Apr 19, 2016
• Online Publication Date: Apr 26, 2016
• Publication Date: May 1, 2016
• Deposit Date: May 21, 2016
• Publicly Available Date: May 21, 2016
• Journal: Breast Cancer Research and Treatment
• Print ISSN: 0167-6806
• Electronic ISSN: 1573-7217
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 157
• Issue: 1
• Pages: 65-75
• DOI: https://doi.org/10.1007/s10549-016-3804-1
• Keywords: Breast cancer; classification; prognostic index; molecular; clinical; outcome
• Public URL: https://nottingham-repository.worktribe.com/output/782153
• Publisher URL: http://dx.doi.org/10.1007/s10549-016-3804-1
• Additional Information: Erratum: Unfortunately, the original article was published under CC; BY-NC license, which is not compliant with the author; funder’s OA policy. The article’s correct licence is CC BY; license and the correct open access statement is given; below.; Open access: This article is distributed under the terms; of the Creative Commons Attribution 4.0 International; License (http://creativecommons.org/licenses/by/4.0/), which; permits unrestricted use, distribution, and reproduction in; any medium, provided you give appropriate credit to the; original author(s) and the source, provide a link to the; Creative Commons license, and indicate if changes were; made.
• Contract Date: May 21, 2016