Nottingham Prognostic Index in Triple-Negative Breast Cancer: a reliable prognostic tool?

Abstract

BackgroundA 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 diagnosis in triple-negative breast cancer patients but it is currently accepted that triple-negative breast cancer does not metastasize to axillary nodes and bones as frequently as the non-triple-negative carcinomas, favouring instead, a preferentially haematogenous spread. Hypothetically, this particular tumour dissemination pattern would impair the reliability of using Nottingham Prognostic Index as a tool for triple-negative breast cancer prognostication.MethodsThe present study tested the effectiveness of the Nottingham Prognostic Index in stratifying breast cancer patients of different subtypes with special emphasis in a triple-negative breast cancer patient subset versus non- triple-negative breast cancer.ResultsWe demonstrated that besides the fact that TNBC disseminate to axillary lymph nodes as frequently as luminal or HER2 tumours, we also showed that TNBC are larger in size compared with other subtypes and almost all grade 3. Additionally, survival curves demonstrated that these prognostic factors are equally important to stratify different survival outcomes in non-TNBC as in TNBC. We also showed that the NPI retains the ability to stratify and predict survival of TNBC patients.ConclusionThe importance of this study relies on the need of prognostication improvements on TNBC, showing, at a clinical standpoint, that Nottingham Prognostic Index is as a truthful prognostic tool in TNBC.

Clinicopathological and Prognostic Characteristics of Triple-Negative Breast Cancer (TNBC) in Chinese Patients: A Retrospective Study

“…The discrepancy might be due to the difference in the diagnostic methods as well as other factors. As for the association between TNBC and axillary lymph node metastasis, some studies have shown that TNBC has a higher rate of axillary lymph node metastasis, while others have not found such association (Albergaria et al, 2011). Some studies have even found that TNBC has a lower rate of lymph node metastasis (Tischkowitz et al, 2007), while we have found that TNBC patients have a much higher rate of lymph node positivity.…”

Role of Cyclooxygenase 2 (COX-2) in Prognosis of Breast Cancer

“…Andre Albergaria et al found that NPI is a good predictor of survival in breast cancer [29]. NPI is a reliable index to predict overall survival of breast cancer patients over 5 years [30].…”

Clinicopathological Features and Prognosis of Pregnancy Associated Breast Cancer – A Matched Case Control Study

“…NPI is a continuous variable that combines several prognostic factors of BC (grade, tumor size, number of metastatic lymph nodes) [27,28]. Although there was no significant difference between PABC and non-PABC when tumor size, T, N and grade at initial presentation were assessed separately, the combination of these factors by NPI resulted in significant difference: based on median NPI value the PABC group was categorized as having poor prognosis, while the non-PABC group as having intermediate prognosis.…”