Journal articles: 'Nottingham Prognostic Index (NPI)'

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Akhtar, Zahid Mahmood, Rabia Altaf, Muhammad Shahbaz Amin, and Seema Butt. "Relationship of Nottingham Prognostic Index with prognostic parameters of breast carcinoma." Pakistan Journal of Medical and Health Sciences 16, no. 6 (June 22, 2022): 26–28. http://dx.doi.org/10.53350/pjmhs2216626.

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Background: Breast cancer (BC) is the commonest malignancy in the female and it is gaining its significance due to worldwide rising incidence. It is also important due to 2.5% higher incidence in Pakistan as compared to neighbouring countries. Nottingham prognostic index (NPI) is an important prognostic factor of BC. It provides information about survival and morbidity. There are significant variations in different studies. Aim: To carry out current study relating NPI with various histopathological parameters of BC. Methods: This was a descriptive cross-sectional study. The study was done at the Department of Pathology, King Edward Medical University Lahore with the collaboration of four surgical units of Mayo Hospital Lahore from 2010 to 2019. Total 137 cases of breast carcinoma were included. Information about age, grade, primary tumor size, axillary lymph node status and stage was entered in the pre designed proforma. NPI was calculated as 0.2xtumor size(cm)+lymph node grade. NPI was scored as excellent, good, moderate and poor and its correlation was calculated against primary tumor size, lymph node grade, tumor grade and stage. Results: We studied 137 cases of breast carcinoma with mean age 49.32±11.64 years. Mean NPI was 5.4±1.4 with range of 2.4 to 9.4. NPI scores in poor 65(47.4%) and moderate 61(44.5%) groups were significantly high as compared to good 10(7.3%) and excellent scores 1(0.7%). Most of the cases of poor NPI were in p T3 and p T4 whereas this was p T2 with moderate score. Poor score of NPI was significant in grade 3 which is in contrast to moderate score where grade 2 dominated the picture. Correlation of NPI with LNG was in favor of LNG 1 with good and moderate scores while LNG3 dominated in the poor group. In stage III, 49 cases (35.8%) were seen with poor score of NPI. Conclusion: NPI is an important prognostic parameter and it can be studied with different histopathological parameters to see correlation between them. In the current study majority of the cases of NPI scored at poor and moderate levels. Correlation coefficient was linear, strong and positive especially with LNG. Mean NPI has ascending correlation with these parameters. Thus NPI can be used as a prognostic indicator when comparing with histopathological parameters of BC. Keywords: Breast cancer, NPI, tumor grade, tumor stage, LNG

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Ball, G., C. Lemetre, A. R. Green, I. O. Ellis, and R. Blamey. "O-72 Remodeling the Nottingham Prognostic Index (NPI) for individual prognosis." European Journal of Cancer Supplements 8, no. 6 (September 2010): 27–28. http://dx.doi.org/10.1016/j.ejcsup.2010.06.073.

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Van Belle, V., J. Decock, W. Hendrickx, O. Brouckaert, S. Pintens, P. Moerman, H. Wildiers, et al. "Short-Term Prognostic Index for Breast Cancer: NPI or Lpi." Pathology Research International 2011 (December 28, 2011): 1–7. http://dx.doi.org/10.4061/2011/918408.

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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.

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Morgan, D. A. L., D. M. Sibbering, M. Galea, I. O. Ellis, C. W. Elston, and R. W. Blamey. "Selection for adjuvant systemic therapy using the Nottingham prognostic index (NPI)." Breast 2, no. 3 (September 1993): 206. http://dx.doi.org/10.1016/0960-9776(93)90146-7.

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Shukla, Ashish, S. C. Jain, and Manish Swarnkar. "Correlation of axillary lymph nodes involvement and Nottingham prognostic index with various histopathologic prognostic factors in invasive breast carcinoma." International Surgery Journal 6, no. 4 (March 26, 2019): 1187. http://dx.doi.org/10.18203/2349-2902.isj20191055.

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Background: Breast cancer is the commonest cancer of urban Indian women and the second commonest in the rural women. The clinical management of this tumor relies on various prognostic factors, most importantly lymph node stage, tumor size and histologic grade. There have been attempts at integration of these factors into meaningful indices. The most widely used of these is the Nottingham prognostic index (NPI), this study was aimed to evaluate the NPI in a group of breast cancer patients and to correlate NPI with other clinical and histo-morphological features.Methods: This was a two-year prospective, observational study was done in the Department of Surgery, Tertiary Care Teaching Hospital of Maharashtra, India. A total of 50 patients who presented with invasive carcinoma of breast from October 2016 to October 2018 were enrolled.Results: Most of the patients belonged to the age group of 41 to 50 years (34%) and the mean age of patients in study was 51.18±11.93 years. Left breast was more affected (62%) than the right breast (38%). Majority of the cases had tumor size of <5 cm (70%) and the mean size of was 4.65±1.89 cms. Majority of the patients (62%) belonged to Bloom Richardson (BR) Grade II and 24% of the patients were ER and PR positive. Lymphovascular invasion was present in 74% of the patients. There was significant positive correlation between tumor size and lymph node involvement. Significant correlation was noted between NPI score and tumor size, positive lymph nodes and BR grade. The mean NPI scores in patients with lymphovascular invasion were noted as 4.92±1.05, compared to 4.83±0.93 among the patients in whom lymphovascular invasion was absent (p=0.779). The mean NPI scores in patients with ER-, PR- were slightly high (4.91±0.94) compared to ER+, PR+ patients (4.76±1.19) (p=0.778).Conclusions: NPI is an essential and valuable prognostic indicator, which should be incorporated in breast cancer reporting by the histopathologists and also primary tumor size, lymph node stage and histological grade which provides further guideline to treating clinicians to choose treatment modalities for the patient and in deciding to follow up plan as well.

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Wegscheider, Anne-Sophie, Bernhard Ulm, Kay Friedrichs, Christoph Lindner Lindner, and Axel Niendorf. "Altona Prognostic Index: A New Prognostic Index for ER-Positive and Her2-Negative Breast Cancer of No Special Type." Cancers 13, no. 15 (July 28, 2021): 3799. http://dx.doi.org/10.3390/cancers13153799.

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Breast cancer is a heterogeneous disease representing a number of different histopathologic and molecular types which should be taken into consideration if prognostic or predictive models are to be developed. The aim of the present study was to demonstrate the validity of the long-known Nottingham prognostic index (NPI) in a large retrospective study (n = 6654 women with a first primary unilateral and unifocal invasive breast cancer diagnosed and treated between April 1996 and October 2018; median follow-up time of breast cancer cases was 15.5 years [14.9–16.8]) from a single pathological institution. Furthermore, it was intended to develop an even superior risk stratification model considering an additional variable, namely the patient’s age at the time of diagnosis. Heterogeneity of these cases was addressed by focusing on estrogen receptor-positive as well as Her2-negative cases and taking the WHO-defined different tumor types into account. Calculating progression free survival Cox-regression and CART-analysis revealed significantly superior iAUC as well as concordance values in comparison to the NPI based stratification, leading to an alternative, namely the Altona prognostic index (API). The importance of the histopathological tumor type was corroborated by the fact that when calculated separately and in contrast to the most frequent so-called “No Special Type” (NST) carcinomas, neither NPI nor API could show valid prognostic stratification.

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Thangjam, D., S. K. Agrawal, S. Chatterjee, and R. Ahmed. "Nottingham Prognostic index (NPI) – a Simple Predictive Tool for Operable Breast Cancer." Clinical Oncology 29, no. 3 (March 2017): e75. http://dx.doi.org/10.1016/j.clon.2016.10.017.

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Fong, Y., J. Evans, D. Brook, J. Kenkre, P. Jarvis, and K. Gower-Thomas. "The Nottingham Prognostic Index: five- and ten-year data for all-cause Survival within a Screened Population." Annals of The Royal College of Surgeons of England 97, no. 2 (March 2015): 137–39. http://dx.doi.org/10.1308/003588414x14055925060514.

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Introduction The Nottingham Prognostic Index (NPI) is an established prognostication tool in the management of breast cancers (BCs). Latest ten-year survival data have demonstrated an improved outlook for each NPI category and the latest UK five- and ten-year survival from BC has been reported to be 85% and 77%, respectively. We compared survival of each NPI category for BCs diagnosed within the national breast screening service in Wales (Breast Test Wales (BTW)) to the latest data, and reviewed its validity in unselected cases within a screened population. Methods All women screened between 1998 and 2001 within BTW were included. The NPI score for each cancer was calculated using the size, nodal status, and grade of the primary tumour. Survival data (all-cause) were calculated after ten years of follow-up. Results In the three-year screening period, 199,082 women were screened. A total of 1,712 cancers were diagnosed, and 1,546 had data available for calculating the NPI. Overall five-year and ten-year survival was 94% and 82%, respectively. Conclusions Overall five-year and ten-year survival (all-cause) has improved even when compared with UK data for BC-specific survival. We found that the NPI remains valid for BC treatment, and that our data provide a reference for updating the all-cause survival of women diagnosed with BCs within a screened population.

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Zhou, Li, Maria Rueda, and Abedalrhman Alkhateeb. "Classification of Breast Cancer Nottingham Prognostic Index Using High-Dimensional Embedding and Residual Neural Network." Cancers 14, no. 4 (February 13, 2022): 934. http://dx.doi.org/10.3390/cancers14040934.

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The Nottingham Prognostics Index (NPI) is a prognostics measure that predicts operable primary breast cancer survival. The NPI value is calculated based on the size of the tumor, the number of lymph nodes, and the tumor grade. Next-generation sequencing advancements have led to measuring different biological indicators called multi-omics data. The availability of multi-omics data triggered the challenge of integrating and analyzing these various biological measures to understand the progression of the diseases. High-dimensional embedding techniques are incorporated to present the features in the lower dimension, i.e., in a 2-dimensional map. The dataset consists of three -omics: gene expression, copy number alteration (CNA), and mRNA from 1885 female patients. The model creates a gene similarity network (GSN) map for each omic using t-distributed stochastic neighbor embedding (t-SNE) before being merged into the residual neural network (ResNet) classification model. The aim of this work was to (i) extract multi-omics biomarkers that are associated with the prognosis and prediction of breast cancer survival; and (ii) build a prediction model for multi-class breast cancer NPI classes. We evaluated this model and compared it to different high-dimensional embedding techniques and neural network combinations. The proposed model outperformed the other methods with an accuracy of 98.48%, and the area under the curve (AUC) equals 0.9999. The findings in the literature confirm associations between some of the extracted omics and breast cancer prognosis and survival including CDCA5, IL17RB, MUC2, NOD2 and NXPH4 from the gene expression dataset; MED30, RAD21, EIF3H and EIF3E from the CNA dataset; and CENPA, MACF1, UGT2B7 and SEMA3B from the mRNA dataset.

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Hasby, Eiman Adel, and Rana Adel Khalifa. "Expression of CD74 in Invasive Breast Carcinoma: Its Relation to Nottingham Prognostic Index, Hormone Receptors, and HER2 Immunoprofile." Tumori Journal 103, no. 2 (February 11, 2016): 193–203. http://dx.doi.org/10.5301/tj.5000562.

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Purpose To study the immunohistochemical expression of CD74 in series of invasive breast carcinomas classified according to their estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) immunoprofile and explore its correlation to Nottingham Prognostic Index (NPI) and tumor pathologic stage to determine if it has a prognostic value. Methods A total of 160 cases of mammary carcinoma were classified broadly according to their ER, PR, and HER2 expression into luminal, HER2-positive, and triple-negative groups. The NPI was calculated and pathologic stage was recorded for each individual case and cases were classified into different prognostic groups. The CD74 expression was evaluated immunohistochemically and correlated to different prognostic variables. Results The CD74 immunohistochemical expression in invasive breast carcinoma was significantly higher in triple-negative tumors, higher tumor grades, presence of lymph nodal metastasis, higher tumor stages, and higher NPI scores. Conclusions The CD74 might be a useful prognostic indicator predicting poor outcome of patients with breast carcinoma. Its consistent expression in triple-negative breast carcinomas points to the need of further studies to test the possibility if it can be targeted in treatment of breast carcinoma, especially in such groups.

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Pradhan, A., P. Paudyal, AK Sinha, and CS Agrawal. "Grading, staging and Nottingham prognostic index scoring of breast carcinoma." Journal of Pathology of Nepal 7, no. 1 (March 30, 2017): 1078–83. http://dx.doi.org/10.3126/jpn.v7i1.16951.

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Background: Breast carcinoma is the most frequent malignant tumor in women accounting for approximately 15% of female cancer deaths. It is the second most common malignancy among women in Nepal. Our objectives were to study the extent and spread of different histological types breast carcinoma in the eastern region of Nepal, to grade and stage the tumors, score the prognosis.Materials and Methods: A cross-sectional descriptive study of mastectomy specimens with axillary lymph node sampling was done for a period of two years. Diagnosis was done using WHO classification. Modified Bloom Richardson score and TNM system was used to grade and stage the tumors. Nottingham Prognostic index was applied to score the prognosis.Results: Out of 31 total cases, the most common histologic type was Invasive Carcinoma of No Special Type (67.74%). The largest tumor size was of 12cm which had poor NPI score. Most tumors were of grade II and T2. Out of 30 cases with lymph nodes, 13 were negative for metastasis pN0, 10 were pN1 and 7 were pN2. Extranodal spread was observed in 6 out of 17 cases with lymph node metastasis and was associated with higher grades and poor prognosis.Conclusion: Higher grade tumors, lymph node metastasis and extranodal extension are associated with higher Nottingham Prognostic Index score.

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Van Belle, Vanya, Ben Van Calster, Olivier Brouckaert, Isabelle Vanden Bempt, Saskia Pintens, Vernon Harvey, Paula Murray, et al. "Qualitative Assessment of the Progesterone Receptor and HER2 Improves the Nottingham Prognostic Index Up to 5 Years After Breast Cancer Diagnosis." Journal of Clinical Oncology 28, no. 27 (September 20, 2010): 4129–34. http://dx.doi.org/10.1200/jco.2009.26.4200.

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PurposeTo investigate whether the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) can improve the Nottingham Prognostic Index (NPI) in the classification of patients with primary operable breast cancer for disease-free survival (DFS).Patients and MethodsThe analysis is based on 1,927 patients with breast cancer treated between 2000 and 2005 at the University Hospitals, Leuven. We compared performances of NPI with and without ER, PR and/or HER2. Validation was done on two external data sets containing 862 and 2,805 patients from Oslo (Norway) and Auckland (New Zealand), respectively.ResultsIn the Leuven cohort, median follow-up was 66 months, and 13.7% of patients experienced a breast cancer–related event. Positive staining for ER, PR, and HER2 was detected, respectively, in 86.9%, 75.5%, and 11.9% of patients. Based on multivariate Cox regression modeling, the improved NPI (iNPI) was derived as NPI − PR positivity + HER2 positivity. Validation results showed a risk group reclassification of 20% to 30% of patients when using iNPI with its optimal risk boundaries versus NPI, in a majority of patients to more appropriate risk groups. An additional 10% of patients were classified into the extreme risk groups, where clinical actions are less ambiguous. Survival curves of reclassified patients resembled more closely those for patients in the same iNPI group than those for patients in the same NPI group.ConclusionThe addition of PR and HER2 to NPI increases its 5-year prognostic accuracy. The iNPI can be considered as a clinically useful tool for stratification of patients with breast cancer receiving standard of care.

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Malmström, P., P.-O. Bendahl, P. Boiesen, N. Brünner, I. Idvall, and M. Fernö. "S-Phase Fraction and Urokinase Plasminogen Activator Are Better Markers for Distant Recurrences Than Nottingham Prognostic Index and Histologic Grade in a Prospective Study of Premenopausal Lymph Node–Negative Breast Cancer." Journal of Clinical Oncology 19, no. 7 (April 1, 2001): 2010–19. http://dx.doi.org/10.1200/jco.2001.19.7.2010.

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PURPOSE: Histologic grade, Nottingham Prognostic Index (NPI), estrogen receptor (ER) and progesterone receptor (PgR) status, and tumor size have previously been shown to be important prognostic indicators for distant recurrence of breast cancer. The purpose of this study was to compare the prognostic value of these factors with flow cytometric S-phase fraction (SPF), urokinase plasminogen activator (uPA), and plasminogen activator inhibitor type 1 (PAI-1) in premenopausal patients with lymph node–negative breast cancer. PATIENTS AND METHODS: In 237 consecutive premenopausal patients with lymph node–negative breast cancer and freshly frozen tumor material available, SPF, ER and PgR status, uPA and its inhibitor PAI-1, histologic grade, and NPI were evaluated. RESULTS: SPF was univariately the most powerful prognostic factor for distant recurrence, followed by uPA, histologic grade, PgR, age, ER, NPI, and PAI-1, the latter being nonsignificant. Multivariate analysis revealed that neither NPI nor histologic grade was significant after adjustment for SPF, a fact that may be explained by the strong association between these factors. uPA was, however, an independent prognostic factor in addition to SPF, NPI, or histologic grade. CONCLUSION: In this prospective study, SPF and uPA were found to be independent prognostic factors in premenopausal women with lymph node–negative breast cancer. We suggest that SPF, if performed under standardized conditions, can replace histologic grade as a selection instrument for adjuvant medical treatment. The value of the combination of SPF and uPA needs to be confirmed in an independent prospective trial.

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Rakha, E. A., D. Soria, A. R. Green, C. Lemetre, D. G. Powe, C. C. Nolan, J. M. Garibaldi, G. Ball, and I. O. Ellis. "Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer." British Journal of Cancer 110, no. 7 (March 11, 2014): 1688–97. http://dx.doi.org/10.1038/bjc.2014.120.

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Holli, K., R. W. Blarney, G. R. Ball, I. O. Ellis, and S. Pinder. "External validation in ONCOPOOL of updated survival according to the Nottingham Prognostic Index (NPI)." European Journal of Cancer Supplements 6, no. 7 (April 2008): 186–87. http://dx.doi.org/10.1016/s1359-6349(08)70776-6.

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Green, Andrew R., D. Soria, D. G. Powe, C. C. Nolan, M. Aleskandarany, M. A. Szász, A. M. Tőkés, et al. "Nottingham prognostic index plus (NPI+) predicts risk of distant metastases in primary breast cancer." Breast Cancer Research and Treatment 157, no. 1 (April 26, 2016): 65–75. http://dx.doi.org/10.1007/s10549-016-3804-1.

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O'Connor, Darran, Catherine Margaret Kelly, John Crown, Niamh Russell, Stephen Barron, Tony Loughman, Seodhna Lynch, et al. "Additional prognostic value of OncoMasTR multigene prognostic signature to clinicopathological information in patients with HR-positive, HER2-negative, lymph node-negative breast cancer from the TAILORx Tissue Bank, Ireland." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 535. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.535.

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535 Background: Multigene prognostic signatures (MGPS) can identify early stage breast cancer patients who may require less aggressive treatment. To be clinically useful, MGPSs must provide additional prognostic information to clinicopathological information routinely used by clinicians. The OncoMasTR MGPS was discovered via a novel bioinformatic transcriptional network analysis. OncoMasTR consists of genes – Master Transcription Regulators (MTRs) – that regulate previously known prognostic genes and have identified functional roles in several hallmarks of cancer including proliferation, invasion and metastasis. The OncoMasTR Molecular Score (OM) consists of just 3 MTRs. The OncoMasTR Risk Score (OncoMasTR) combines OM with lymph node status and tumour size, and categorises patients as low or high risk. The OncoMasTR Test has been analytically and clinically validated. Methods: MTR expression was measured by RT-qPCR in tissue from 404 patients enrolled in an independent translational trial (NCT02050750) that collected tissue and clinical data from patients enrolled in TAILORx in Ireland. OM, OncoMasTR and Oncotype DX Recurrence Score (RS) were compared on the additional prognostic value they provided to Ki67, Nottingham Prognostic Index (NPI) and other clinicopathological information for distant recurrence (DR) and invasive disease (ID). Results: OM (LRχ2 = 20.3, p < 0.00001, c-index = 0.84) and OncoMasTR (LRχ2 = 22.6, p < 0.00001, c-index = 0.85) were significantly prognostic, and more prognostic than RS (LRχ2 = 8.4, p = 0.004, c-index = 0.73) for DR. OM and OncoMasTR provided more additional prognostic information than RS to Ki67, NPI, tumour size, tumour grade, and age for DR. Similar results were found when OM, OncoMasTR and RS were compared on prognostic performance for ID. Conclusions: OM and OncoMasTR were significantly prognostic for DR and ID and added significant prognostic value to Ki67, NPI, and other clinicopathological information. Furthermore, OM and OncoMasTR showed superior prognostic performance to RS.

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Rizki, Hirah, Christopher Hillyar, Omar Abbassi, Gillian Clayton, Sascha Dua, Tasha Gandamihardja, and Simon Smith. "P091. Oncotype DX, Predict, and the Nottingham Prognostic Index (NPI) – A study in decision making." European Journal of Surgical Oncology 45, no. 5 (May 2019): 909. http://dx.doi.org/10.1016/j.ejso.2019.01.113.

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Nesrine, M., H. El Benna, Y. Berrazegua, S. Labidi, N. Daoud, and H. Boussen. "Significance of receptors expression, mitotic index and Ki67 in breast cancer patients with Nottingham Prognostic Index (NPI) poor prognosis score." Annals of Oncology 29 (October 2018): viii69. http://dx.doi.org/10.1093/annonc/mdy270.211.

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Gonzalez, Michael A., Sarah E. Pinder, Grace Callagy, Sarah L. Vowler, Lesley S. Morris, Kate Bird, Jane A. Bell, Ronald A. Laskey, and Nicholas Coleman. "Minichromosome Maintenance Protein 2 Is a Strong Independent Prognostic Marker in Breast Cancer." Journal of Clinical Oncology 21, no. 23 (December 1, 2003): 4306–13. http://dx.doi.org/10.1200/jco.2003.04.121.

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Purpose: To test the hypothesis that prognostic information in breast cancer may be derived from an accurate assessment of epithelial cell cycle entry, as indicated by expression of minichromosome maintenance (MCM) proteins. Materials and Methods: We used immunohistochemistry to examine the distribution of Mcm-2 in breast tissue. Power calculations based on a pilot study of 67 whole tissue sections led to selection of an independent 347-core breast carcinoma tissue microarray validation set. We tested for associations between Mcm-2 (and Ki-67) labeling index (LI) and various clinicopathologic parameters. Results: Mcm-2 was expressed more frequently than the standard proliferation marker Ki-67 in whole tissue sections of normal breast (P = .0003) and breast carcinoma (P < .0001). In 221 assessable cores of invasive carcinoma, the Mcm-2 LI showed a positive association with tumor size (P = .002), mitotic index (P < .0001), histologic grade (P < .0001), and the Nottingham Prognostic Index (NPI) score (P < .0001). Using a cutoff value of 50%, Mcm-2 LI was associated with overall survival (P = .0007), disease-free interval (P = .0002), and with the development of regional recurrence (P = .011) and distant metastases (P = .0016). Cox regression analysis suggested that the Mcm-2 LI is a strong prognostic factor in breast cancer that is independent and superior to histologic grade, lymph node stage, and Ki-67 LI, but not the NPI score. Conclusion: Mcm-2 may be of utility as a prognostic marker to refine the prediction of outcome in breast cancer, for example when combined with parameters currently used in the NPI.

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Cuperjani, Frederik, Lumturije Gashi, Fisnik Kurshumliu, Shemsedin Dreshaj, and Fitim Selimi. "Relationship between Ribosomal Protein S6-pS240 Expression and other Prognostic Factors in Non-Special Type Invasive Breast Cancer." Breast Care 14, no. 3 (November 14, 2018): 171–75. http://dx.doi.org/10.1159/000491427.

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Background: The aim of this study was to investigate the immunohistochemical expression of ribosomal protein (RP) S6-pS240 in non-special type invasive breast cancer in relation to other prognostic markers and gain new insights to facilitate more individualized treatment. Methods: The following clinical and histopathological parameters of 120 patients were determined: S6-pS240 expression, age, menopausal status, tumor size and grade, TNM stage, Nottingham Prognostic Index (NPI), lymph node stage, estrogen and progesterone receptor (ER/PR) expression, HER2/neu amplification, lymphovascular invasion, and proliferative index as measured by Ki-67. Treatment protocol and disease-free survival were evaluated accordingly. Results: Significant positive correlations were seen between S6-pS240 expression and Ki-67 values (rho = 0.530, p < 0.001), and NPI (rho = 0.370, p < 0.001) and HER2/neu amplification (rho = 0.368, p < 0.001). A negative correlation was found between S6-pS240 and ER/PR expression (rho = 0.362, p < 0.001). Patients with negative RP S6-pS240 expression had significantly longer disease-free survival (log-rank test, p = 0.005). Conclusion: Immunohistochemical analysis of RP S6-pS240 is a valuable additional prognostic marker in patients with invasive breast cancer. Routine use of S6-pS240 immunohistochemistry is recommended.

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Abrial, C., X. Durando, P. Chollet, O. Tacca, I. Raoelfils, M. Mouret-Reynier, P. Gimbergues, and F. Penault-Llorca. "Comparison between two prognostic index: Nottingham index (NPI) and an alternative index based on log of nodal involvement (Lpi)." Journal of Clinical Oncology 26, no. 15_suppl (May 20, 2008): 22146. http://dx.doi.org/10.1200/jco.2008.26.15_suppl.22146.

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Holli, K., R. W. Blamey, M. J. Mitchell, M. Blichert-Toft, L. Cataliotti, I. O. Ellis, A. Fourquet, et al. "O-62 External validation in ONCOPOOL of updated survival according to the Nottingham Prognostic Index (NPI)." European Journal of Cancer Supplements 5, no. 3 (September 2007): 19. http://dx.doi.org/10.1016/s1359-6349(07)71752-4.

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Green, Andrew R., D. Soria, D. G. Powe, C. C. Nolan, M. Aleskandarany, M. A. Szász, A. M. Tőkés, et al. "Erratum to: Nottingham prognostic index plus (NPI+) predicts risk of distant metastases in primary breast cancer." Breast Cancer Research and Treatment 159, no. 1 (July 22, 2016): 199. http://dx.doi.org/10.1007/s10549-016-3907-8.

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Malami, S. A., and S. M. Sahabi. "Relevance of modified prognostic score for breast carcinoma on fine needle aspiration cytology in a resource-poor setting." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 21177. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.21177.

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21177 Background: Breast cancer is the commonest malignancy in premenopausal Nigerian women in whom it is almost uniformly fatal probably due to lack of access to early diagnosis and treatment. To enhance the value of fine needle aspiration cytology, a rapid and comparatively new technique in our center, we sought to verify if it is also a cost-effective test to predict biological behavior in breast carcinoma. We developed a modified grading system to compare the cytologic features of the cases in our series with known prognostic factors (tumours size, histologic grade and axillary lymph node status) in subsequently excised tissues. Methods: Fine needle aspirates obtained in 42 patients diagnosed as ductal cell carcinoma not otherwise specified (NOS) at the UDUTH Hospital, Sokoto, Nigeria were investigated. The three cytologic features used were nuclear grade (score 1–3), cellular dyscohesion (score 1–3), and bare atypical nuclei (score 0, 1). A cytological score of 3 and below was considered a low score, and a score of 4–7 was considered a high score. We also categorized each patient according to the Nottingham Prognostic Index (NPI) into: good prognostic group (GPG), moderate prognostic group (MPG) and poor prognostic group (PPG). The cases in GPG and MPG were considered to belong to a more favourable category. Results of cytoprognostic scores were compared with the respective pathological information calculated by the NPI. Results: Eighteen of the 20 cases that had a cytologically high score were confirmed to be PPG while 2 correlated with MPG. Among the 22 cases that had cytologically low scores 14 cases were not correlated with favourable NPI index (belonged to PPG category) while the remaining 8 correlated well (MPG = 4 and GPG = 4). The overall accuracy for cytologic grading was 62% (26 out of 42 cases). Conclusion: Tumour typing on FNA material correlates with the NPI in the poor prognostic group. However, this modified cytoprognostic score seems to have doubtful promise as a prognostic factor in our group of patients with favourable NPI. The importance of each cytological feature used in this grading system will be determined by regression analysis in a larger sample size. No significant financial relationships to disclose.

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Quintyne, Keith Ian, Bernie Woulfe, and Rajnish K. Gupta. "Correlation between 21-gene recurrence score assay with Nottingham prognostic index (NPI) and Adjuvant! Online (AO) prognostic tools in newly diagnosed patients with early-stage breast cancer in midwestern Ireland." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e16551-e16551. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e16551.

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e16551 Background: Prognostic tools such as NPI and AO have been used to help stratify early stage breast cancer patients into specific risk-related groupings. With the development of molecular biological gene expression assays, both predictive and prognostic information for patients with early stage endocrine positive breast cancer can be determined. We herein report our experience with the use of a 21-gene recurrence score (RS) assay, it’s correlation with NPI and AO, and explore the comparative outcome for patients in MWCC, Limerick, Ireland. Methods: Study period: 01/09/2008 – 31/12/2012. Data was derived from (1) MWCC Oncology database (2) MWRH pathology reports (3) MWRH patient files (4) RS assay reports. Data was collated and entered into an Access database and exported into Predictive Analytics Software for analysis. Results: Seventy-seven (77) patients with early stage endocrine positive breast cancer were analysed. Median age: 55.9 years (range: 30.6 – 72.3 years). Median follow-up: 15.4 months. NPI distribution was: excellent – 9%, good – 53%, moderate – 38% and poor – 0%, with median NPI score – 3.36. RS distribution was: low – 49%, intermediate – 43% and high – 8%, with median RS – 18. The RS correlated poorly with NPI predictions. The median AO benefit 10-year survival with no additional therapy – 81.4%, the median AO additional benefit 10-year survival of chemotherapy (CT) – 1.2% and median AO additional benefit 10-year survival of CT and hormonal therapy (HT) – 3.9%. The RS also correlated poorly with AO predictions. Conclusions: Prognostic tools are useful in evaluating and predicting the possible outcome, but they do not correlate well with this 21-gene RS molecular assay, as seen with our cohort. These tools should therefore be used in tandem, together with good clinical judgement on an individual basis when advising patients on potential treatment pathways. Further long term evaluation is required.

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Agnani, Bhawna, Ranjana Solanki, Maryem Ansari, and Sankalp Agnani. "Prognostic Significance of Microvessel Density as Assessed by anti CD34 Monoclonal Antibody in Invasive Ductal Carcinoma of Breast." Asian Pacific Journal of Cancer Biology 5, no. 3 (September 15, 2020): 75–79. http://dx.doi.org/10.31557/apjcb.2020.5.3.75-79.

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Context and Aim: Breast carcinoma is one of the leading causes of cancer related mortality in females. A number of established prognostic indicators exist for breast cancer. One potential indicator of adverse prognosis in breast cancer is tumor induced angiogenesis. Hematogenous spread of tumor cells is quantitatively related to microvessel density (MVD). This study aims to find possible association of microvessel density with other recognized prognostic factor such as patient age, tumor size, lymph node status, histologic grade, Nottingham Prognostic Index (NPI), vascular invasion, hormone receptor status and HER2/Neu expression in breast carcinoma.Methods and Materials: This is a cross sectional, laboratory based descriptive type of observational study. This study was carried out in the Department of Pathology, SMS medical college. In our study we did histological evaluation of mastectomy specimen of breast cancer including ER, PR and Her 2 status and calculated the microvessel density (MVD) in appropriate section by applying IHC. MVD correlation with other clinicopathological parameters was done. Stastical analysis used in this study include Fischer Exact test and Chi Square test. Results: A significant correlation was obtained between MVD and tumor size, lymph node metastasis, lymphovascular invasion, histologic grade and NPI (P value of 0.01). Conclusions: Angiogenesis is an important component of cancer growth, invasion and metastasis. Therefore, inhibition of angiogenesis is an attractive strategy for treatment of cancer. The correlation of MVD with prognosis suggests the utility of antiangiogenic drugs in breast cancer patients with high angiogenesis

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Elwood, M., S. Tin Tin, E. Tawfiq, R. J. Marshall, T. M. Phung, R. Lawrenson, I. Campbell, and V. Harvey. "A New Predictive Model for Breast Cancer Survival in New Zealand: Development, Internal and External Validation, and Comparison With the Nottingham Prognostic Index." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 227s. http://dx.doi.org/10.1200/jgo.18.91800.

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Background: Women diagnosed with breast cancer, their doctors, and their families, would find a valid estimate of her prognosis helpful in planning treatment and support. Assessing prognosis is complex as many factors influence it. Several predictive models have been produced, but none has been developed or tested on patients in New Zealand (NZ). Aim: We aimed to develop and validate a NZ predictive model (NZPM) for breast cancer, and compare its performance to a widely used UK-developed model, the Nottingham Prognostic Index (NPI). Methods: We developed a model to predict 10-year breast cancer-specific survival, using data collected prospectively in the largest population-based breast cancer registry in NZ (Auckland, 9182 patients), and assessed its performance in this data set (internal validation) and in an independent NZ population-based series of 2625 patients in Waikato (external validation). The data included all women with primary invasive breast cancer diagnosed from 1 June 2000 to 30 June 2014, with follow-up to death or to 31 December 2014. We used multivariate Cox proportional hazards regression to assess predictors and to estimate the probability of breast cancer mortality within 10 years, and therefore 10-year survival, for each patient. We assessed observed survival by the Kaplan-Meier method. We assessed discrimination by the C-statistic, and calibration by comparing predicted and observed survival rates for patients in 10 groups ordered by predicted 10-year survival. We compared this NZPM with the NPI in the validation data set. Results: The final NZPM used continuous variables of age, tumor size, and number of positive lymph nodes, and categorical variables of ethnicity, tumor stage, tumor grade, ER and PR receptors, HER2 status, and histologic type of tumor. Discrimination was good: C-statistics were 0.84 for internal validity and 0.83 for independent external validity. For calibration, for both internal and external validity, the predicted 10-year survival probabilities in 10 groups of patients, ordered by predicted survival, were all within the 95% confidence intervals (CI) of the observed Kaplan-Meier survival probabilities. The NZPM showed good discrimination even within the prognostic groups defined by the NPI. Conclusion: These results for the NZPM show good internal and external validity, transportability, potential clinical value, and its clear superiority over the NPI. Further research will assess other potential predictors, other outcomes, performance in specific subgroups of patients, and compare the NZPM to other models, which have been developed in other countries and have not yet been tested in NZ.

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Gallagher, Emily, Derek Leroith, Sheldon M. Feldman, Elisa R. Port, Neil B. Friedman, Susan K. Boolbol, Brigid K. Killelea, et al. "Are racial differences in obesity and insulin resistance related to aggressive breast cancer?" Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18157-e18157. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18157.

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e18157 Background: Black women are more likely to die of breast cancer and develop more aggressive subtypes than white women. Black women are also more likely to be obese and have insulin resistance than white women. Insulin resistance has been associated with faster tumor growth but has not been studied as a potential mediator of racial disparities in women with breast cancer. We hypothesized that black women would present with more aggressive breast cancer and this would be associated with obesity and insulin resistance. Methods: We recruited 1017 (80% white, 20% black) women with new primary breast cancer, measured fasting blood glucose and insulin, body mass index (BMI), triple negative breast cancer (TNBC) & Nottingham prognostic index (NPI). We classified aggressive breast cancer as NPI > 4.4. We calculated insulin resistance scores (HOMA) and classified insulin resistance as HOMA > 2.8. Patients self-identified race. Results: Of 1017 women, average age was 58 years (SD = 12.0). 373 (37%) were stage 2+ at time of diagnosis; 19% had an NPI > 4.4. Black women presented with higher stage of cancer than white women (stage 2+: 45% vs 35%; p = 0.01), more TNBC than white women (10% vs 5%, p = 0.01), were more insulin resistant (24% vs 11%, p < .0001), had higher BMI (31.4kg/m2 vs 26.6 kg/m2; p < .0001) and NPI > 4.4 (29% vs. 17%, p = 0.0002) than white women. HOMA score was positively but not significantly associated with NPI score (r = 0.05; p = 0.1). Multivariate mediation regression model suggested that HOMA_IR does not mediate the effect from black race to higher NPI score (β = 0.01; 95%CI: -0.017 to 0.039). Conclusions: In women with newly diagnosed breast cancer, black women are more likely to be obese, have higher HOMA & NPI scores than white women. While these data are consistent with the hypothesized relationship of hyperinsulinemia promoting more aggressive breast cancer, to date, insulin resistance does not appear to mediate the effect of race and poor prognostic breast cancer.

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Agrawal, S., D. Thangjam, and A. Rosina. "Nottingham Prognostic index (NPI) − a simple predictive tool for operable breast cancer − utility in non screened cohort." European Journal of Cancer 72 (February 2017): S14. http://dx.doi.org/10.1016/s0959-8049(17)30125-9.

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Campone, M., C. Charbonnel, F. Magrangeas, S. Minvielle, J. Genève, A. Martin, R. Deporte, R. Bataille, L. Campion, and P. Jézéquel. "Establishment of a predictive classifier of node-positive breast cancer patients treated by FEC100 chemotherapy using gene expression profiling." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 13004. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.13004.

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13004 Background: In breast cancer treatment, biomarkers providing information about chemotherapy sensitivity are needed. FEC100 combination, frequently prescribed in Europe, is still applied empirically to patients. Our study’s goal was to establish a classifier of sensitivity to this regimen using gene expression data and classical clinicopathologic parameters. Methods: The study retrospectively included 151 patients belonging to the FEC100 arms of two multicentric phase III clinical trials: PACS01 (n = 128) and PEGASE01 (n = 23) (FNCLCC). Patients had unilateral breast cancer, showed no evidence of distant metastasis, were node-positive, aged less than 65-year-old. Median follow-up was 5 years. The number of relapses were respectively 23 and 10. We used cDNA nylon microarrays containing 7,000 genes to analyze gene expression profiles of tumor. Patients were split into a training set and a test set. A 3-step analysis based on Cox regression was applied: 1) elimination of non discriminant genes, 2) robust (resampling) univariate selection of discriminant genes and 3) development of multivariate models combining the discriminant genes, the Nottingham Prognostic Index (NPI) (developed in 2 binary variables) and the hormonal receptors. As a final step, after dichotomization of the retained genes, a risk score was built and applied first on the test set, and then on the whole cohort. Kaplan-Meier curves and logrank tests were performed to assess the new risk score. Results: The new risk score (one gene [G6224] and NPI) permitted to separate patients from the test set in 3 significantly different groups; it was also an improvement on NPI (test set: NPI, p = 0.0005; risk score p = 0.0001 - whole cohort: NPI, p = 2.10−5; risk score, p = 1.10−10). Conclusions: We identified G6224 whose expression combined with NPI showed a good capacity for classifying breast cancer patients who received FEC100 chemotherapy. Our results strengthen the interest of G6224 since it was previously described in various solid tumors as a prognostic biomarker with a tumor-suppressor activity. No significant financial relationships to disclose.

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Wen, Jiahuai, Feng Ye, Shuaijie Li, Xiaojia Huang, Lu Yang, Xiangsheng Xiao, and Xiaoming Xie. "The Practicability of a Novel Prognostic Index (PI) Model and Comparison with Nottingham Prognostic Index (NPI) in Stage I–III Breast Cancer Patients Undergoing Surgical Treatment." PLOS ONE 10, no. 11 (November 23, 2015): e0143537. http://dx.doi.org/10.1371/journal.pone.0143537.

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Green, N., A. Al-Allak, and C. Fowler. "Benefits of introduction of Oncotype DX® testing." Annals of The Royal College of Surgeons of England 101, no. 1 (January 2019): 55–59. http://dx.doi.org/10.1308/rcsann.2018.0173.

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Introduction Decisions regarding adjuvant chemotherapy in women with oestrogen receptor positive, human epidermal growth factor receptor 2 negative, node negative, early invasive breast cancer are unclear. The Recurrence Score® (RS) from Oncotype DX® (ODX) testing guides decisions based on individual cancer genomics. The aim of this study was to evaluate the impact of introducing ODX results on adjuvant treatment decisions and its potential economic benefits. Methods Patients offered the test were identified from the ODX requesting system. Information on reasons behind chemotherapy treatment decisions were collected from clinical letters and the pathology system. The Nottingham prognostic index (NPI) scores were calculated for each individual patient. Results A total of 101 patients were identified as having undergone ODX testing over 21 months. The median age was 57 years (range: 41–72 years), the median NPI was 3.70 (range: 3.40–5.26) and the median RS was 17 (range: 0–59). NPI did not predict the risk category. All of the patients in the high risk group, 35.1% in the intermediate risk group and 5.4% in the low risk group received chemotherapy. The majority of low risk patients who received chemotherapy made a decision prior to the ODX result. Conclusions In our unit, RS aided our decision making regarding adjuvant chemotherapy. Patients with a higher RS were more likely to receive chemotherapy. If NPI had been used alone, more women would have been offered chemotherapy. Good communication with patients prior to testing is important to ensure it is cost effective.

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Liu, Ming, Shao-Xian Tang, Julia Y. S. Tsang, Yu-Jie Shi, Yun-Bi Ni, Bonita K. B. Law, and Gary M. K. Tse. "Core needle biopsy as an alternative to whole section in IHC4 score assessment for breast cancer prognostication." Journal of Clinical Pathology 71, no. 12 (September 18, 2018): 1084–89. http://dx.doi.org/10.1136/jclinpath-2018-205228.

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AimsIHC4 score, based on expression of four routine markers (oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and proliferation marker, Ki67), is a recently developed, cost-effective prognostic tool in breast cancer. Possibly, the score may be useful also in advanced diseases where only core needle biopsy (CNB) is available and neoadjuvant therapy. However, its studies on CNB are scant. This study examined whether IHC4 score assessment on CNB is comparable to that from whole section (WS).MethodsImmunohistochemical (IHC) analysis was performed for ER, PR, HER2 and Ki67 on 108 paired CNB and WS to evaluate IHC4 score (with follow-up range 1–230 months and 5 relapse/death). Concordance between the two was examined. Factors that affected the concordance were analysed. Additionally, IHC4 score was compared with Nottingham Prognostic Index (NPI).ResultsThere was moderate concordance between IHC4 score on CNB and WS (all cases: κ=0.699, p<0.001; ER+ cases: κ=0.595, p<0.001). Among the IHC4 components, concordance for HER2 was the poorest (κ=0.178, p<0.001 in all cases; ER+ cases: κ=0.082, p<0.097). Significant factors affecting concordance between CNB and WS included number of cores, total core length and percentage of tumour cells in cores (p≤0.030), indicating the importance of sufficient sampling. Interestingly, the concordance was also affected by patients’ age (p=0.039). There was poor agreement between IHC4 score and NPI (κ≤0.160).ConclusionOur results suggested that IHC4 score can be used on adequately sampled CNB. Its poor agreement with NPI highlights the independence of the two factors.

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Blamey, R., H. G. Bishop, G. M. Lawrence, S. Pinder, R. Wilson, and A. Evans. "The prognoses of tumours detected in the UK breast screening programme (NHS BSP) analysed by the Nottingham Prognostic Index (NPI)." European Journal of Cancer Supplements 2, no. 3 (March 2004): 180. http://dx.doi.org/10.1016/s1359-6349(04)91031-2.

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Xiang, Yan, Li Li, Mark Zarella, Katarzyna Brzezinska, Kareem Hosny, Steve Hou, and Fernando Garcia. "B-Cell lymphoma 2 Protein Expression and Established Clinicopathologic Features in Breast Cancers." American Journal of Clinical Pathology 152, Supplement_1 (September 11, 2019): S51. http://dx.doi.org/10.1093/ajcp/aqz113.035.

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Abstract Objectives B-cell lymphoma 2 (Bcl-2) proto-oncogene alterations are involved in tumor genesis and play a vital role in regulating cell apoptosis. The objective of this research is to determine the prognostic value of quantitative expression of the Bcl-2 protein in breast cancer. Methods This study investigated a series of 158 primary breast cancers for Bcl-2 protein expression. Results were correlated with clinicopathologic features (age, tumor size, tubule formation, nuclear pleomorphism, mitotic count, and Nottingham prognostic index: NPI) and a panel of markers of established or presumed predictive values. Results Bcl-2 H-score (multiplied by staining intensity and percentage of positive cells) was observed to have a significant reversed correlation with the Magee Equation 1, 2, 3 (P1 < .001, P2 < .001, P3 < .001, r1 = –0.36, r2 = –0.34, r3 = –0.34). High proliferative activity as assessed by Ki-67 (>25%) staining negatively associated with Bcl-2 H-score (P = .03). Low Bcl-2 H-score was associated with old age (age >63, P = .039). Bcl-2 cytoplasm percent positive score was negatively associated (P = .02, n = 92) with overexpression of p53 (positive percentage >1.5). High Bcl-2 H-score was also associated with tumor size (T >1.5 cm, P = .034), but there was no significant correlation observed between Bcl-2 expression and the NPI calculated using the size of the lesion, the number of involved lymph nodes, and the grade of the tumor (NPI >3.4, P = .317). Conclusion (1) This study reports a correlation between Bcl-2 H-score and all three Magee equation values. (2) Bcl-2 H-score provides prognostic value better than percentage of positive cells. (3) This study further reports a correlation between Bcl-2 H-score and age, tumor size, Ki-67, and p53, irrespective of the type of adjuvant therapy received and across molecular subtypes. Collectively, these results establish the rationale for introduction of semiquantitative expression of the Bcl-2 protein to improve prognostic stratification of breast cancer patients.

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Egorov, M. V., V. E. Sinitsyn, and A. V. Bakunovich. "Magnetic Resonance Spectroscopy in the Diagnosis and Prognosis of Breast Cancer." Journal of radiology and nuclear medicine 100, no. 5 (November 4, 2019): 293–97. http://dx.doi.org/10.20862/0042-4676-2019-100-5-293-297.

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Objective. To evaluate the efficiency of magnetic resonance spectroscopy in the diagnosis and prognosis of breast cancer (BC).Material and methods. Twenty-eight patients aged 37 to 80 years with established primary invasive BC were examined. Its grade was determined according to pathomorphological verification with immunohistochemical analysis. Breast MRI was performed using the standard protocol, by determining the measured diffusion coefficient (MDC), dynamic contrast enhancement (DCE). Proton magnetic resonance spectroscopy was carried out using the Breeze software package. The clinical and morphological findings and the results of radiation studies were compared to determine Nottingham prognostic index (NPI) scores. To identify the Spearman rank correlation coefficient between MRI findings (the type of pharmacokinetic curves, the total choline-containing (tCho) peak integral) and the values characterizing tumor size and grade.Results. NPI calculation showed that the scoring range was 2.4 to 6.76; the expected 5-year survival rates reached 93%. The mean MDC was 0.856×10-3 mm2/sec; type II pharmacokinetic curve prevailed (n=16; 57.1%). There was a statistically significant negative correlation between the values of MDC, the type of a contrast agent accumulation curve, the levels of HER2/neu and the proliferation marker Ki-67; there was a statistically significant strong positive correlation between the presence of 1H-MPC tCho peak and the indicators determining tumor malignancy (the levels of HER2/neu and Ki-67). Statistically significant differences between the type of a pharmacokinetic curve in DCE and the level of tCho in the prognostic groups defined when calculating NPI were determined in patients with moderate (n=4; 14.2%) and poor (n=10; 35.7%) prognosis.Conclusion. The capabilities of MR spectroscopy are superior in information content to the data obtained by determining the MDC, the nature of contrast medium accumulation in breast tumor, and are comparable with the data determining the type of a tumor (the presence of the HER2/neu gene, Ki-67 proliferation marker) in predicting BC cancer grade and 5-year survival rates.

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Kumari, Priyanka, Sumit Bhaskar, Rajiv Ranjan, and Dipendra Kumar Sinha. "Incidence of triple negative breast cancer at Rajendra Institute of Medical Sciences, Ranchi." International Surgery Journal 6, no. 9 (August 28, 2019): 3134. http://dx.doi.org/10.18203/2349-2902.isj20194045.

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Background: Breast carcinoma is the second most common carcinoma in women and accounts for 22% of all female cancer, which is more than twice the prevalence of cancer in women at any other site. Triple negative breast cancer, i.e., negative expression of oestrogen and progesterone receptors and HER2/neu receptors and accounts for approximately 10-17% of all breast carcinomas, is biologically aggressive, resistant to conventional cytotoxic chemotherapy treatment, and is associated with reduced survival compared to other subtypes of breast cancer.Methods: History, local examination, Various investigations like: FNAC of breast lump and axillary lymph node, USG of breasts and axilla, USG of whole abdomen and pelvis, Chest X-ray PA View etc, ER/PR and HER-2/neu status on the specimen sent for HPE were done. The prognostic implications on ER, PR and HER-2/neu receptors were assessed indirectly with the help of Nottingham prognostic index (NPI)).Results: A statistically significant correlation of ER/PR receptor status was found with tumour size, no. of lymph nodes, tumour grade and NPI, whereas HER2/neu receptor status had a statistically significant correlation with tumour size and no. of lymph node involved. Incidence of triple negative breast cancer in this Institute is 20%.Conclusions: ER, PR and HER2/neu receptor status is highly important predictor in cases of carcinoma breast which necessitates routine evaluation of these receptor statuses for better management of disease.

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Iftikhar, Muhammad Adil, Khalil Ahmed, Usman Ali Rahman, Malihajavaid Butt, Iftikhar Ahmed, and M. Kaleem Akhtar. "Recurrence Rate of Carcinoma Breast patients Undergoing Mastectomy at Gulab Devi Hospital Lahore." Pakistan Journal of Medical and Health Sciences 15, no. 7 (July 26, 2021): 1464–66. http://dx.doi.org/10.53350/pjmhs211571464.

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Aim: To determine recurrence rate of carcinoma breast after mastectomy in our population and to determine various risk factors associated with local recurrence which would help in management of new carcinoma breast patients in future. Methods: It was a descriptive study conducted on patients of carcinoma breast with stage II and III undergoing modified radical mastectomy with negative resection margins at Gulab Devi Hospital, Lahore. Total of 59 patients were recruited in study using purposive sampling technique. Results: Mean age was 51.61±11.52 years with range from 26 to 78 year. Female 58(98.31%) predominated over the 1(1.69%) male. Recurrence rate was seen only in 5 (8.47%) female patients Conclusion: Proper surgical technique results in less chances of carcinoma breast recurrence. Menopause, positive axillary lymphnodes, lymphovascular invasion and necrosis on histology are associated factors of recurrence. MeSH: Carcinoma breast, recurrence, Nottingham Prognostic Index (NPI)

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Tsang, Yuk-Wah, Chi-Hsun Liao, Chiao-Hsu Ke, Chi-Wen Tu, and Chen-Si Lin. "Integrated Molecular Characterization to Reveal the Association between Kynurenine 3-Monooxygenase Expression and Tumorigenesis in Human Breast Cancers." Journal of Personalized Medicine 11, no. 10 (September 24, 2021): 948. http://dx.doi.org/10.3390/jpm11100948.

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Kynurenine 3-monooxygenase (KMO) is overexpressed in several tumors and participates in the progression of breast cancer tumorigenesis, including cancer types such as triple-negative breast cancer (TNBC). This malignant gene is an enzyme in the kynurenine pathway, which is involved in the carcinogenesis of cancer through immune function manipulation. However, it remains unclear whether the role of the KMO contributes to tumorigenesis and immune functions in human breast cancer. In this study, we found that KMO was highly expressed in different types of tumors, especially in invasive ductal breast carcinoma. In addition, KMO expression was positively correlated with the malignant clinical features of patients with breast cancer, such as TNBC and a nodal-positive status, along with patients with a higher Nottingham prognostic index (NPI). Furthermore, the top ten KMO-correlated genes were the chemokines and pro-inflammatory cytokines known to be involved in the progression of various cancers, therefore, KMO may facilitate breast cancers via synergistically regulating inflammatory responses in tumors with these hub genes. Taken together, these findings highlight the tumor-promotion role of KMO in breast cancers and suggest that KMO can serve as a biomarker for prognosis prediction in breast cancer patients.

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Giltnane, J. M., J. Rapp, C. Moeder, R. L. Camp, H. Kluger, A. Molinaro, and D. Rimm. "Construction of a five-marker protein-based model for stage-independent assessment of prognosis in breast cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 11013. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.11013.

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11013 Background: While the TNM method for assessment of stage in breast cancer is simple and robust, molecular methods for limited patient subsets are gaining popularity (i.e Oncotype Dx or Mammaprint). We hypothesized that multiplexed quantitative measurement of proteins known to be involved in breast cancer signaling pathways of growth, proliferation, survival, and metastasis can enhance clinical methods of predicting prognosis in all patients. Methods: We assessed the expression of twenty-three proteins (ER, PR, EGFR, HER2, HER3, HER4, ERK, PTEN, PI3Kp85α, PI3Kp110α, p27/Kip1,EIF4E, FOXO3,AKT1, AKT2, AKT3, MYC, cyclinD1, FOXO1, mTOR, p70S6Kb, NFkB and BCL2) in four subcellular compartments by automated quantitative analysis of protein expression (AQUA) on tissue microarrays of the archival Yale breast cancer cohort (n=676). To project future performance of these markers including clinicopathological parameters, we constructed univariate and multivariate logistic regression models using leave-one-out cross-validation and calculated prediction error (PE) estimates of each model's value to predict a binary endpoint of 10 year survival. In addition, we constructed univariate and multivariate Cox models of ten year disease specific survival (DSS). Results: By Cox univariate analysis, ER, PR, PTEN, and BCL2 were directly correlated with DSS, while FOXO1, HER2, HER3, and PI3Kp110α were inversely correlated with DSS. A five-variable logistic regression model of 10 year survival including nuclear AKT1, BCL2, nuclear FOXO1, cytoplasmic mTOR, and nuclear p70S6Kb (prediction error= .274) surpasses performance of TNM staging (PE=.367) and the Nottingham Prognostic Index (PE=.326). The same model is associated with 10-year DSS by Cox proportional hazard (p=<.00001) independent of TNM stage and NPI. Conclusions: Our protein-based, multiplexed approach to prognostic classification was superior to traditional methods (TNM or NPI) and single biomarkers in this retrospective cohort. Current outcomes are influenced by modern therapies, limiting the direct impact of this analysis. However, molecular profiling of primary tumor linked to outcome paves the way for the incorporation of new prognostic models into prospective studies. [Table: see text]

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Li, Qin, Li Li, Xiaoyue Jiang, Qi Du, Yingrui Li, Teng Li, Hong Gong, and Bangwei Cao. "Characteristics and prognostic values of traditional pathological parameters and advanced molecular subtypes in women in Beijing with operable breast cancer: a retrospective analysis." BMJ Open 8, no. 11 (November 2018): e021819. http://dx.doi.org/10.1136/bmjopen-2018-021819.

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ObjectivesThis study investigated the characteristics and prognostic values of traditional pathological parameters and advanced molecular subtypes in women with operable breast cancer in Beijing.DesignA retrospective study through case information enquiry or telephonic follow-up.SettingBeijing Friendship Hospital.Participants1042 patients with primary operable breast cancer between 2008 and 2012 were enrolled in the study.MeasuresThe characteristics and 5-year relapse rates according to the Nottingham Prognosis Index (NPI) and molecular subtypes were analysed.ResultsIn 1042 patients, the percentages of high histological grade, N1+N2, T2+T4 were 7.3%, 24.2%, 46.9%, respectively. In patients with invasive breast cancer, the percentages of auxiliary staging, positive margins, vascular invasion and nerve infiltration were 65.0%, 2.8%, 10.5% and 1.1%, respectively. The missing percentages of auxiliary staging, margins, vascular tumour invasion and nerve infiltration were 14.2%, 31.4%, 46.5% and 97.4%, respectively. The percentages of ER-positive, PR-positive, HER2-positive and Ki-67 high expression were 64.3%, 43.8%, 18.8% and 62.7%, respectively. The percentages of luminal A, luminal B, HER2-overexpression and basal-like breast cancers were 10.5%, 54.2%, 8.2% and 11.2%, respectively. Luminal A, luminal B and basal-like breast cancer subtypes were more common in the >60 years group, the 41–60 years group and the 20–40 years group, respectively. The 5-year relapse rates according to NPI were as follows: 6.2% in the low recurrence risk group, 10.4% in the moderate recurrence risk group and 12.9% in the high recurrence risk group. The 5-year relapse rates according to molecular subtypes were as follows: luminal A 4.0%, luminal B 7.0%, HER2-overexpression14.2%, basal-like 15.6%.ConclusionsReasonable analysis of traditional pathological parameters and advanced molecular subtypes in women with operable breast cancer in Beijing may be useful to guide precise treatment and predict prognosis.

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Shatnawi, Aymen, Nehad M. Ayoub, Amer E. Alkhalifa, and Dalia R. Ibrahim. "Estrogen-Related Receptors Gene Expression and Copy Number Alteration Association With the Clinicopathologic Characteristics of Breast Cancer." Breast Cancer: Basic and Clinical Research 16 (January 2022): 117822342210867. http://dx.doi.org/10.1177/11782234221086713.

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Purpose: It has been suggested that dysregulation of transcription factors expression or activity plays significant roles in breast cancer (BC) severity and poor prognosis. Therefore, our study aims to thoroughly evaluate the estrogen-related receptor isoforms (ESRRs) expression and copy number alteration (CNA) status and their association with clinicopathologic characteristics in BC. Methods: A METABRIC dataset consist of 2509 BC patients’ samples was obtained from the cBioPortal public domain. The gene expression, putative CNA, and relevant tumor information of ESRRs were retrieved. ESRRs messenger RNA (mRNA) expression in BC cell lines was obtained from the Cancer Cell Line Encyclopedia (CCLE). Association and correlation analysis of ESRRs expression with BC clinicopathologic characteristics and molecular subtype were performed. Kaplan–Meier survival analysis was conducted to evaluate the prognostic value of ESRRs expression on patient survival. Results: ESRRα expression correlated negatively with patients’ age and overall survival, whereas positively correlated with tumor size, the number of positive lymph nodes, and Nottingham prognostic index (NPI). Conversely, ESRRγ expression was positively correlated with patients’ age and negatively correlated with NPI. ESRRα and ESRRγ expression were significantly associated with tumor grade, expression of hormone receptors, human epidermal growth factor receptor 2 (HER2), and molecular subtype, whereas ESRRβ was only associated with tumor stage. A significant and distinct association of each of ESRRs CNA with various clinicopathologic and prognostic factors was also observed. Kaplan–Meier survival analysis demonstrated no significant difference for survival curves among BC patients with high or low expression of ESRRα, β, or γ. On stratification, high ESRRα expression significantly reduced survival among premenopausal patients, patients with grade I/II, and early-stage disease. In BC cell lines, only ESRRα expression was significantly higher in HER2-positive cells. No significant association was observed between ESRRβ expression and any of the clinicopathologic characteristics examined. Conclusions: In this clinical dataset, ESRRα and ESRRγ mRNA expression and CNA show a significant correlation and association with distinct clinicopathologic and prognostic parameters known to influence treatment outcomes; however, ESRRβ failed to show a robust role in BC pathogenesis. ESRRα and ESRRγ can be employed as therapeutic targets in BC-targeted therapy. However, the role of ESRRβ in BC pathogenesis remains unclear.

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Ahmed, Nagwa Abd El-Sadek, and Maisa Hashem Mohammed. "Significance of CD133 Expression in Invasive Ductal Carcinoma of the Breast." Asian Pacific Journal of Cancer Biology 7, no. 1 (February 23, 2022): 9–14. http://dx.doi.org/10.31557/apjcb.2022.7.1.9-14.

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Background and Aim: Cancer stem cells (CSCs) are thought to be responsible for tumor initiation, progression, and resistance to chemotherapy and radiotherapy. CD133 is a trans-membrane glycoprotein which is considered as a putative CSCs marker. Emerging evidence suggests that CD133 may be a critical factor in tumor development, progression and metastasis. The aim of this study was to evaluate the expression of CD133 in mammary infiltrating ductal carcinoma (IDC), and to correlate its expression with some known clinicopathological parameters. Methods: Fifty patients with mammary IDC who underwent modified radical mastectomy were included in this study. From each specimen, two tissue sections were obtained; one was stained by hematoxylin and eosin (H&E) stain to determine the histologic subtype, grade and indicators of local aggressiveness. The second tissue section was immunohistochemically stained by anti-human CD133 antibody. Results: The study revealed statistically significant associations between CD133 expression and poorly differentiated, advanced stage tumors with poor Nottingham Prognostic Index (NPI), triple negative phenotype, lymphovascular invasion (LVI) and lymph node metastasis (LNM). Conclusion: The current study revealed that CD133 is strongly associated with poor prognostic indices; it is positively correlated to poorly-differentiated tumors with high histologic grade and advanced stage

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Wang, Tian, Ting Zhou, Fangfang Fu, Yingyan Han, Yan Li, and Ming Yuan. "HMGA1 As a Potential Prognostic and Therapeutic Biomarker in Breast Cancer." Disease Markers 2022 (November 26, 2022): 1–12. http://dx.doi.org/10.1155/2022/7466555.

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Background. High-mobility group AT-hook1 (HMGA1) protein plays an important role in various diseases. However, the contribution of HMGA1 in breast cancer remains to be tapped. Methods. The expression of HMGA1 was analyzed in The Cancer Genome Atlas (TCGA) and TIMER database, and immunohistochemistry was performed in 39 breast cancer (BC) patients. The correlation between HMGA1 expression and prognosis was evaluated using Kaplan–Meier plotter (KM plotter) in patients with breast cancer. Then, cBioPortal and bc-GenExMiner were requisitioned to analyze the contribution of HMGA1 expression to clinical features. In order to reveal the function of HMGA1 in breast cancer cells, enrichment analysis was performed using the clusterProfiler R software package. Moreover, CCK8 assay, EdU assay, and Cell Cycle Assay were performed to assess the proliferation, and transwell assay was used to evaluate cell migration and invasion. Flow cytometry was used to explore the role of HMGA1 on cell apoptosis. After that, the effect of HMGA1 on signaling pathways in BC cells was detected by western blot. Results. HMGA1 was highly expressed in a variety of tumors tissues, including BC. High HMGA1 expression was correlated with poor prognosis in BC patients. Meanwhile, HMGA1 expression was increased in molecular phenotypes with poor prognosis (ER-, PR-, and HER2+) and associated with high-grade group, lymph node metastasis, and NPI (Nottingham Prognostic Index). Further, function analysis revealed HMGA1 was enriched in DNA replication and cell cycle pathways in breast cancer. Moreover, knockdown of HMGA1 caused apoptosis, inhibited proliferation, migration, and invasion of MCF-7 and MDA-MB-231 cells, in which the oncogenic signaling pathway of PI3K/AKT/MMP9 played a critical role. Conclusions. HMGA1 was important for breast cancer progression and was a critical prognostic indicator, prompting a potential therapeutic target of breast cancer.

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Quintyne, K. I., B. Woulfe, and R. K. Gupta. "Retrospective application of Nottingham Prognostic Index (NPI) and Adjuvant! Online tool in newly diagnosed patients with early breast cancer in mid-western Ireland." Journal of Clinical Oncology 28, no. 15_suppl (May 20, 2010): 6139. http://dx.doi.org/10.1200/jco.2010.28.15_suppl.6139.

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Vallejo, C. T., J. A. Lacava, P. M. Cabaleiro, P. Butín, M. Cari, S. E. Albornoz, J. R. Castro, A. Novoa, M. Mac Donnell, and B. A. Leone. "The Nottingham Prognostic Index (NPI) applied to 467 patients (pts) with a long-term follow-up that were treated in a single institution." Journal of Clinical Oncology 22, no. 14_suppl (July 15, 2004): 9657. http://dx.doi.org/10.1200/jco.2004.22.90140.9657.

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Vallejo, C. T., J. A. Lacava, P. M. Cabaleiro, P. Butín, M. Cari, S. E. Albornoz, J. R. Castro, A. Novoa, M. Mac Donnell, and B. A. Leone. "The Nottingham Prognostic Index (NPI) applied to 467 patients (pts) with a long-term follow-up that were treated in a single institution." Journal of Clinical Oncology 22, no. 14_suppl (July 15, 2004): 9657. http://dx.doi.org/10.1200/jco.2004.22.14_suppl.9657.

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Jasar, Dzengis N., Katerina B. Kubelka-Sabit, and Vanja A. Filipovski. "Impact of the nottingham prognostic index (NPI) on the occurrence of relapses compared with the HER-2/neu expression in breast cancer patients." Pathology 46 (2014): S57. http://dx.doi.org/10.1097/01.pat.0000454295.14782.1f.

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Mane, Vaibhav, Nekta Anand, and Darshana Wakkar. "Correlation ER/PR status of Breast Carcinoma with Tumor size, Tumor grade, Lymphovascular emboli, Lymph node metastasis and the distant metastasis." IP Archives of Cytology and Histopathology Research 6, no. 3 (September 15, 2021): 191–96. http://dx.doi.org/10.18231/j.achr.2021.043.

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Breast cancer is the most frequent cancer in females in the world and is the second most common cancer in India after cervical cancer. The breast cancer is second most common reason of loss of existence in each developed and additionally most of the growing countries. For the appraisal of prognosis of breast cancer commonly followed is the NOTTINGHAM PROGNOSTIC INDEX (NPI) which includes- tumor size, histological tumor grade, lymph node metastasis and hormone receptor status. These prognostic component help in administration and therapeutic requirement of breast cancer patient.1. To study the MRM specimens for size, grade of the tumor, LVI and LN metastases and the ER/PR receptors of the tumor. 2.To study the association of ER/PR status with the above mentioned prognostic parameters.This three-year study includes 50 histopathologically confirmed cases of carcinoma breast. The tumor type, grade, LNM, LVE were reported on H & E. The ER-PR study was done of all 50 cases. The tumor size, grade, NM, LVE were correlated with receptor status. Out of 50 cases majority (7.5%) of cases were in 41-50 years of age group, and tumor size was between 2-4 cm in (17.5%) cases; majority were of grade II carcinoma (17.5%) of which 13% were ER-PR positive. Out of 35 cases with negative LNM and LVE, 26 cases (13%) were ER-PR positive.In our observation there is no association between higher histological grade and ER-PR status. No obvious correlation with tumor size was noted. But increase in tumor size could also be a poor predictor of ER-PR status. LNM, LVE is poor predictor of ER-PR status.

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Journal articles on the topic 'Nottingham Prognostic Index (NPI)'

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