Nottingham Prognostic Index: Useful tool to assess outcome inpatients of breast carcinoma

Abstract

Breast cancer has been ranked number one cancer among the Indian females surpassing the incidence of cervical cancer. Multiple clinico-pathological-molecular prognostic factors are available in decision making about potentially suitable treatment options for breast cancer. Among all, Nottingham Prognostic Index (NPI) is the most powerful integrated index. Present study aimed to evaluate the significance of NPI in prognosis of operable breast cancer patients. Materials and Methods: This longitudinal (Descriptive) study was carried on 60 female patients of operable breast carcinoma at tertiary care centre in central India. Results: Two patients from good prognostic group (NPI≤3.4) (30%) had metastasis to bone & CNS. F rom moderate prognostic group ((NPI 3.4 -5.4) (50%) , one patient had recurrence at previous surgical scar site and 3 patients had metastasis to liver, lung and supraclavicular lymph node each. However the worst outcome was found in patients from poor prognostic group (NPI > 5.4) (10%). Five patients from poor prognostic group had metastasis in liver, bone, CNS and lung with two patients had simultaneous metastasis in liver & bone. Four patients from poor prognostic group had death within two and half year s of primary diagnosis. Out of 60 patients, 34 patients had a follow up of more than 1000 days, so were included in statistical analysis of survival based on Cox Proportional Hazard Model. Among 7 variables, NPI was found to be statistically most significant with p value 0.001 Conclusion: Estimation of NPI is the powerful and reproducible index for assessing prognosis in patients with operable breast cancer in advanced resources deprived institute. Main strength of NPI lies in the fact that it is based on relatively simple data which can be provided in routine histopathology report of carcinoma breast.