Nottingham Prognostic Index is an Applicable Prognostic Tool in Non-Metastatic Triple-Negative Breast Cancer

Abstract

Introduction: Triple-negative breast cancer (TNBC) is characterized by a poor prognosis due to high mortality<br />and early relapse, requiring the study of its prognostic factors. Tumor size, histological grade and lymph node status<br />represent important parameters that are widely studied in breast cancer, and are retained as prognostic factors by several<br />international guidelines. The Nottingham team combined these parameters into a prognostic score called the Nottingham<br />prognostic index (NPI). In this study, we investigated the influence of NPI on outcomes in non metastatic TNBC.<br />Methodology: This retrospective cohort study included all female patients with non metastatic TNBC who received<br />treatment at the Regional Oncology Center Hassan II Oujda - Morocco, between January 2009 and December 2011.<br />The prognostic impact of the NPI on the survival curves at 5 years was studied using multivariate Cox proportional<br />hazards models. Results: The analysis of the data involved 98 patients, 39 patients (39.8%) were classed in the poor<br />prognosis group with a NPI > 5.4. The Overall survival (OS) and Disease free survival (DFS) rates at 5 years, in this<br />group, were 70 and 55.6 % respectively. After adjusting for clinic-pathological variables, a NPI > 5.4 was associated with<br />mortality (HR: 2.598, 95% CI: 1.423 – 4.744, p = 0.002) and disease progression (HR: 2.512, CI to 95%: 1.496 – 4.219,<br />p <0.001) in patients with non-metastatic TNBC. Conclusion: This retrospective cohort analysis showed that NPI was<br />an independent prognostic factor for OS and DFS at 5 years in women with non metastatic TNBC. Once validated, the<br />impact of this score on survival outcomes could be considered in the clinical management of TNBC.