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Applying the Nottingham Prognostic Index to a Swedish breast cancer population
Department of Surgery, County Hospital, Kalmar, Sweden.
Department of Cytology and Pathology, County Hospital, Kalmar, Sweden.
Department of Physiology, County Hospital, Kalmar, Sweden.
Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
1999 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 53, no 1, 1-8 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to assess the applicability of histopathological grading according to the protocol of Elston/Ellis and the Nottingham Prognostic Index (NPI) to a defined breast cancer population. The NPI is the sum of the individual scores concerning grade, tumour size, and lymph node status, each weighted according to regression coefficients of a Cox proportional hazard analysis and calculated for each individual breast cancer patient. 630 consecutive patients with invasive breast cancer diagnosed 1988–91 were retrospectively followed up and their tumours reviewed and graded. A Cox proportional hazard analysis was performed. Grade, lymph node status, and tumour size were statistically significant predictors of survival within the follow up period (median 7.2 years). Similar to NPI, a temporary index (Kalmar Prognostic Index, KPI) was derived and normalised to NPI for comparison (KPI(norm)). NPI and KPI(norm) gave similar prognostic power in spite of the differences of the patient populations from which the 2 indices were derived. Patients with NPI 4 or less had 0.66% breast cancer specific mortality during the follow up time. 14% of the patients with NPI 4.1–5 and 32% of those with an index sum 5.1–6 died from breast cancer during this time. Younger patients tended to have higher grade tumours. We advocate the common use of grade and the NPI in order to increase the comparability of groups of patients receiving different therapies.

Place, publisher, year, edition, pages
1999. Vol. 53, no 1, 1-8 p.
Keyword [en]
breast cancer, histopathological grade, Nottingham Prognostic Index, prognosis
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-25294DOI: 10.1023/A:1006052115874Local ID: 9734OAI: diva2:245622
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-08-09Bibliographically approved
In thesis
1. Prognostic Factors in Breast Cancer
Open this publication in new window or tab >>Prognostic Factors in Breast Cancer
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breast cancer is increasing in the industrialised countries. Due to early detection and adjuvaut treatment with radiotherapy, hormones and chemotherapy, mortality has decreased. The different adjuvant treatments have adverse effects. It is an important task is to estimate the risk of recurrence for the individual patient in order to tailor her individual treatment. This thesis aims at identifying predictors for disease development in primary and disseminated breast cancer.

Histologic grade was strongly correlated to breast cancer mortality in 630 patients with primary breast cancer. The combination of grade, tumour size and lymph node status in the Nottingham Prognostic Index provides a powerful instrument separating patients in groups with excellent, good, intermediate and poor prognosis.

Grade was more sensitive than S-phase fraction in identifying high risk patients and patients with very good prognosis.

Presence of cancer cells in blood- and lymph vessels close to the tumour in patients with grade 3 tumours increased the risk oflocoregional recurrence 6-fold as compared to patients with grade 1 or 2 tumours without such vascular invasion.

The mortality of young women with breast cancer has decreased very little since 1960. Women under 37 years of age had increased tumour size, more metastatic lymph nodes and doubled rate of high grade tumours as compared to older women.

Disease-free interval and survival in patients with distant recurrence were strongly associated to histologic grade and hormone receptor content. Patients with grade 3, hormone receptor negative tumours had a median survival of 10 months after recurrence while only 15 % of women with receptor positive, grade 1 tumours have so far died after a median follow-up time of 5 years after recurrence.

The Nottingham Prognostic Index and assessments of presence of tmnour cells in vessels provide important information about the risk oflocoregional and distant recurrence in breast cancer. Treatment decisions, counselling and follow-up programmes should be based on such assessments. For patients with metastatic breast cancer, tumour grade, estrogen receptor status and serum-c-erbB-2 predict the course of the disease.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 64 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 632
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-25716 (URN)10093 (Local ID)91-7219-589-4 (ISBN)10093 (Archive number)10093 (OAI)
Public defence
2000-05-26, Ögonklinikens föreläsningssal, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-09Bibliographically approved

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Sundquist, MarieThorstenson, StenBrudin, LarsNordenskjöld, Bo
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