Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer?

Abstract

The Nottingham prognostic index (NPI), based on tumour size in breast, node involvement and Scarff -Bloom -Richardson (SBR) grading, has been shown to constitute a definitive prognostic factor of primary operable breast cancer in the adjuvant setting. We performed a retrospective study to evaluate the prognostic value of this index in 163 patients after neoadjuvant chemotherapy. Secondly, we examined the influence on survival of a revised NPI, only based on residual tumour size in breast and SBR grading in 228 patients, and consequently called breast grading index (BGI). The prognostic value of these two indices was also evaluated by replacing the SBR grade with the MSBR grade, a French modified SBR grading; the modified NPI (MNPI) and modified BGI (MBGI) were, respectively, obtained in 153 and 222 patients. At a median follow-up of 9.3 years, survival was significantly related to these four indices (Po0.001). Multivariate analysis revealed that MBGI was the only one which retained a prognostic influence on disease-free survival (Po0.02). In conclusion, the 'amount' of residual tumour in breast and/or nodes, as defined by NPI and revised indices, confers a determinant prognosis after neoadjuvant chemotherapy, inviting an alternative postsurgical treatment for a subgroup of patients with a decreased survival.

Pathologic Response and Long-Term Follow-up in Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: A Comparison Between Classifications and Their Practical Application

“…23,24 Residual Disease in Breast and Nodes (RDBN) uses the formula RDBN ¼ 0.2 3 tumor size (cm) þ lymph node stage (0-3) þ histologic grade (1-3), which takes into account tumor size, lymph node stage, and histologic grade to determine the levels of response. [25][26][27] Residual ductal carcinoma in situ is compatible with complete pathologic response in the NSABP-B18, RDBN, and RCB classifications, and MillerPayne grade 5. 3,21,23,26,28 We chose the classifications for their basis in histopathology and because they provide a spectrum ranging from simple dichotomy (NSABP-B18) and linear histologic response in breast only (Miller-Payne) or breast and lymph nodes (Sataloff) to more complex algorithms, including a formula (RDBN) or Web calculator (RCB).…”

“…25,31,36 In RDBN, high tumor grade weighs in as a negative prognostic factor when residual tumor is present, in addition to lymph node involvement and tumor size. 26 Other post-NACT response classifications discussed in this study do not consider histologic grade.…”

“…26 Other post-NACT response classifications discussed in this study do not consider histologic grade. 6,[21][22][23]25,36,39 The favorable survival of low-grade tumors in our cohort coincided with the one of complete responders, and those were high grade. 25,26,31,40 Prior studies emphasized the lack of response to NACT for invasive lobular carcinomas or other low-grade breast cancers.…”

“…6,[21][22][23]25,36,39 The favorable survival of low-grade tumors in our cohort coincided with the one of complete responders, and those were high grade. 25,26,31,40 Prior studies emphasized the lack of response to NACT for invasive lobular carcinomas or other low-grade breast cancers. 8,41,42 Overall, high tumor grade was associated with less favorable survival, which is in agreement with other studies whose classifications use histologic grade.…”

Usefulness of serum CA 15.3 and histopathological prognostic indices in breast cancer

“…The ten-year survival rates in these categories were 88 %, 70 % and 40 % respectively with a 'p' value less than 0.0001. In another study conducted by P. Chollet et al (8), itwas concluded that pabents with an NPI less than 4 had a better prognosis than others, wi',h ten-year survival rates of 91.2 % and 84.6 % respectively. CA 15.3 is the most widely used serum biochemical tumor marker in breast cancer (9).…”