![]() The current Nottingham Prognostic Index (NPI) 4, 5, 6 is based on a combination of histopathological factors (tumour size, lymph node stage and tumour grading) integrated in a prognostic index formula 7 which can be used to stratify BC patients with operable early stage primary BC into prognostic groups. However, the incorporation of molecular taxonomy of BC using gene expression profiling into routine clinical decision‐making has not proved entirely successful due to factors including reproducibility, validation, cost and lack of utility for all BC patients. ![]() ![]() There has been increasing interest in use of multigene assays, such as Oncotype DX ® 2 and MammaPrint ® 3, and their potential clinical utility in BC management. Personalised treatment plans for BC require integration of clinical, histopathological and biological information to effectively stratify patients with regard to their expected outcome and response to the various applicable treatment options. However, clinical decision making in personalised BC treatment requires robust and accurate risk stratification based on outcome prediction and biology 1. With the number of available treatment options, making the most appropriate treatment choice is increasingly difficult and complex and, therefore, a more personalised management of BC is required. Further validation in large randomised controlled trial material is warranted.īreast cancer (BC), is one of the leading causes of death in women but it represents a very heterogeneous group of tumours in terms of genotype, phenotype, behaviour and response to treatment. This study demonstrates the reproducibility of NPI+ and confirmed its prognostic value in an independent cohort of primary BC. 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. 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). The biological classes were significantly associated with patient outcome ( p 0.01). The NPI+ biomarker panel classified the Edinburgh series into seven biological classes similar to the Nottingham series ( p > 0.01). 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. 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. Eight hundred and eighty five primary early stage BC cases from Edinburgh were semi‐quantitatively assessed for 10 biomarkers using immunohistochemistry and classified into biological classes by fuzzy logic‐derived algorithms previously developed in the Nottingham series. ![]() ![]() This study aimed to validate the NPI+ in an independent series of BC. 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. ![]()
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