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Summary.-From a multiple-regression analysis of prognostic factors and survival in a series of 387 patients with primary breast cancer, a prognostic index has been constructed, based on lymph-node stage, tumour size and pathological grade. This index is more discriminating than lymph-node stage alone, and enables a larger group of patients to be identified with a very poor prognosis.

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Summary A prognostic index, previously derived in a group of 387 patients with primary breast cancer, has been recalculated for the same patients with over 5 years further follow-up and shown to be unchanged. The prognostic index has also been applied prospectively to a further group of 320 patients and shown to be similarly effective in identifying patients with either a very good or a very poor prognosis. It has been verified that the index applies to patients with primary breast cancer. Patients have now been divided into 5 prognostic groups, predicting 11% of patients with an almost normal survival and a further 10% with a very poor prognosis. The index is used to stratify patients to study the effects of treatment regimes within groups of similar patients.It would be of considerable value in the management of breast cancer patients to be able to predict more accurately the clinical course of the disease at the time of initial treatment. In studies of breast cancer many factors may appear to indicate prognosis if studied in isolation or in small groups. To obtain a true indication of the prognostic importance of these factors it is necessary to employ a form of multivariate analysis such as that described by Cox (1972) which can make use of all the data from a group of patients having a wide range of survival times.The where size is in cm, stages A, B and C (see below) are coded 1-3 and grade is also coded 1-3.The index was computed for each patient, who was then assigned to one of three prognostic groups: Good (1<3.4), Moderate (3.4 5.4).Lifetable analysis of the patients in the Good prognostic group showed a survival of 88% at 5 years against 21 % in the Poor prognostic group. Since the method of obtaining the index relied on the best fit to retrospective data it is essential to perfect the index prospectively. This paper applies the prognostic index prospectively to a second group of patients with primary breast cancer who have presented since since our first report.The power of the prognostic factors might alter with time, e.g., factors predicting survival at 10 years might be different from those predicting 5 year survival. The analysis has been re-applied to the original group of patients, now with longer follow-up. Patients and methodsThe patients in the two groups were treated under the care of a single surgeon (RWB)

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