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Nottingham Prognostic Index Plus: Validation of a clinical decision making tool in breast cancer in an independent series.


ABSTRACT: The Nottingham Prognostic Index Plus (NPI+) is a clinical decision making tool in breast cancer (BC) that aims to provide improved patient outcome stratification superior to the traditional NPI. This study aimed to validate the NPI+ in an independent series of BC. Eight hundred and eighty five primary early stage BC cases from Edinburgh were semi-quantitatively assessed for 10 biomarkers [Estrogen Receptor (ER), Progesterone Receptor (PgR), cytokeratin (CK) 5/6, CK7/8, epidermal growth factor receptor (EGFR), HER2, HER3, HER4, p53, and Mucin 1] using immunohistochemistry and classified into biological classes by fuzzy logic-derived algorithms previously developed in the Nottingham series. Subsequently, NPI+ Prognostic Groups (PGs) were assigned for each class using bespoke NPI-like formulae, previously developed in each NPI+ biological class of the Nottingham series, utilising clinicopathological parameters: number of positive nodes, pathological tumour size, stage, tubule formation, nuclear pleomorphism and mitotic counts. Biological classes and PGs were compared between the Edinburgh and Nottingham series using Cramer's V and their role in patient outcome prediction using Kaplan-Meier curves and tested using Log Rank. The NPI+ biomarker panel classified the Edinburgh series into seven biological classes similar to the Nottingham series (p?>?0.01). The biological classes were significantly associated with patient outcome (p??0.01). The good PGs were similarly validated in Luminal B, Basal p53 normal, HER2+/ER- tumours and the poor PG in the Luminal N class (p?>?0.01). Due to small patient numbers assigned to the remaining PGs, Luminal N, Luminal B, Basal p53 normal and HER2+/ER- classes could not be validated. This study demonstrates the reproducibility of NPI+ and confirmed its prognostic value in an independent cohort of primary BC. Further validation in large randomised controlled trial material is warranted.

SUBMITTER: Green AR 

PROVIDER: S-EPMC4858129 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Nottingham Prognostic Index Plus: Validation of a clinical decision making tool in breast cancer in an independent series.

Green Andrew R AR   Soria Daniele D   Stephen Jacqueline J   Powe Desmond G DG   Nolan Christopher C CC   Kunkler Ian I   Thomas Jeremy J   Kerr Gillian R GR   Jack Wilma W   Cameron David D   Piper Tammy T   Ball Graham R GR   Garibaldi Jonathan M JM   Rakha Emad A EA   Bartlett John Ms JM   Ellis Ian O IO  

The journal of pathology. Clinical research 20160115 1


The Nottingham Prognostic Index Plus (NPI+) is a clinical decision making tool in breast cancer (BC) that aims to provide improved patient outcome stratification superior to the traditional NPI. This study aimed to validate the NPI+ in an independent series of BC. Eight hundred and eighty five primary early stage BC cases from Edinburgh were semi-quantitatively assessed for 10 biomarkers [Estrogen Receptor (ER), Progesterone Receptor (PgR), cytokeratin (CK) 5/6, CK7/8, epidermal growth factor re  ...[more]

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