Al- Anbar Medical Journal

Categorization of the Nottingham Prognostic Index in Breast Carcinoma: A Retrospective Study of 473 Female Patients

Document Type : Original articles

Authors

1 department of surgery, college of medicine, university of Duhok, KRG-Iraq

2 department of clinical pharmacology, college of pharmacy, university of Duhok, KRG-Iraq

3 Department of pathology, college of medicine, university of Duhok, KRG-Iraq

4 Department of Surgery , College of Medicine, University of Duhok, KRG-Iraq

Abstract

Background: The Nottingham prognostic index (NPI) combines lymph node status, tumor size, and histological grade, reflecting breast cancer's metastatic behavior, growth rate, and genetic instability. NPI is a commonly used, clinically relevant, and internationally validated system for classifying early and locally advanced breast cancer cases [TNM (tumor, lymph nodes, and metastasis) stages I, II, and III] into three or more prognostic groups. NPI is important for patients and clinicians to decide whether to undergo adjuvant chemotherapy following surgery.
Objectives: To determine the prevalence of various categories of NPI in breast cancer patients in Duhok, Iraqi Kurdistan and to establish a correlation between NPI and a variety of clinical, pathological, and immunohistochemical parameters.
Materials and Methods: This retrospective cross-sectional study was conducted in the Oncology Clinic at Azadi Teaching Hospital, Duhok, Iraq. The data included age, side of the breast involved, multi-centricity of cancer, histological type, NPI category, surgery type, and excision margins. The histopathological data included the type of carcinoma, lympho-vascular invasion (LVI), dermal invasion, and nipple involvement. IHC profile included ER, PR, Her2-neu and ki67 index. These data were expressed in frequencies and percentages, and the NPI was correlated with the previous parameters using appropriate statistical tests, and a P-value < 0.5% is considered a statistically significant difference. 
Results: There was no statistically significant association between NPI and age, focality, and ER status (P-value = 0.93, 0.55, and 0.64, respectively). Significant correlations exist with, dermal involvement, surgical margins involvement, and PR status (P-value = 0.03, 0.029, 0.046, and 0.011, respectively). The correlation is highly significant when the NPI is considered against the stage, Ki-67, and Her2-neu (P-value = 0.001 for all).
Conclusion: Most cases that were examined belonged to the moderate and poor numerical NPI categories, and these NPIs show significant associations with the stage, Ki-67, and Her2-neu.

Keywords

Main Subjects

References
[1]      J. Ferlay et al., “Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012,” Int. J. cancer, vol. 136, no. 5, pp. E359–E386, 2015.
[2]      H. Sung et al., “Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries,” CA. Cancer J. Clin., 2021.
[3]      K. M-amen et al., “Cancer Incidence in the Kurdistan Region of Iraq: Results of a Seven-Year Cancer Registration in Erbil and Duhok Governorates.,” Asian Pacific J. Cancer Prev. APJCP, vol. 23, no. 2, pp. 601–615, 2022.
[4]      T. Foukakis and J. Bergh, “Prognostic and predictive factors in early, non-metastatic breast cancer,” Dizon Ed UpToDate, 2016.
[5]      S. Nimesh, N. Gupta, and R. Chandra, “Nanomedicine for the treatment of breast cancer,” in Post-genomic Approaches in Cancer and Nano Medicine, River Publishers, pp. 267–285, 2022.
[6]      R. Yadav, R. Sen, and P. Chauhan, “Calculation of NPI score: prognosis of breast cancer,” Exec. Ed., vol. 4, no. 4, p. 205, 2013.
[7]      E. Gray, A. Donten, K. Payne, and P. S. Hall, “Survival estimates stratified by the Nottingham Prognostic Index for early breast cancer: a systematic review and meta-analysis of observational studies,” Syst. Rev., vol. 7, no. 1, pp. 1–9, 2018.
[8]      A. H. S. Lee and I. O. Ellis, “The Nottingham prognostic index for invasive carcinoma of the breast,” Pathol. Oncol. Res., vol. 14, pp. 113–115, 2008.
[9]      J. GARNER, “In the case of breast cancer, how can these be combined to give prognostic information?,” Quest. MRCS vivas. London Arnold, p. 231, 2004.
[10]    P. A. Fasching et al., “Ki67, chemotherapy response, and prognosis in breast cancer patients receiving neoadjuvant treatment,” BMC Cancer, vol. 11, no. 1, pp. 1–13, 2011.
[11]    P. Gong, Y. Wang, G. Liu, J. Zhang, and Z. Wang, “New insight into Ki67 expression at the invasive front in breast cancer,” PLoS One, vol. 8, no. 1, p. e54912, 2013.
[12]    S. C. Prabhu, “A study on Nottingham prognostic index and its correlation with ER , PR , HER-2 / NEU and KI-67 in breast carcinomas,” vol. 8, no. 2, pp. 188–192, 2021.
[13]    V. Özmen, T. Özmen, and V. Doğru, “Breast cancer in Turkey; an analysis of 20.000 patients with breast cancer,” Eur. J. breast Heal., vol. 15, no. 3, p. 141, 2019.
[14]    H. Abdel-Razeq et al., “Late presentation and suboptimal treatment of breast cancer among Syrian refugees: a retrospective study,” J. Int. Med. Res., vol. 49, no. 5, p. 03000605211018448, 2021.
[15]    M. H. Amer, “Genetic factors and breast cancer laterality,” Cancer Manag. Res., pp. 191–203, 2014.
[16]    R. F. Neri A, Marrelli D, Megha T, Bettarini F, Tacchini D, De Franco L, “Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases,” BMC Surg., vol. 15, no. 1, pp. 1–10, 2015.
[17]    J. R. Bundred et al., “Margin status and survival outcomes after breast cancer conservation surgery: Prospectively registered systematic review and meta-analysis,” bmj, vol. 378, 2022.
[18]    U. Güth, H. Moch, L. Herberich, and W. Holzgreve, “Noninflammatory breast carcinoma with skin involvement: clinical diagnosis is relevant to appropriate classification in the TNM system,” Cancer, vol. 100, no. 3, pp. 470–478, 2004.
[19]    A. Tevfik, H. Yabanoğlu, M. Erkent, P. Börcek, and K. U. Ş. Murat, “Paget’s Disease Of The Breast: Clinical-Pathological Findings And Surveillance,” Çukurova Anestezi ve Cerrahi Bilim. Derg., vol. 3, no. 3, pp. 230–238, 2020.
[20]    P. Narayan et al., “Perineural invasion as a risk factor for locoregional recurrence of invasive breast cancer,” Sci. Rep., vol. 11, no. 1, p. 12781, 2021.
[21]    S. Sadiq, U. Rihan, B. Parveen, J. Ahsan, A. Shafiq, and S. Shaukat, “Ki-67 EXPRESSION STATUS IN INVASIVE CARCINOMAS OF BREAST: A CO-RELATION WITH CLINICO-PATHOLOGIC AND PROGNOSTIC PARAMETERS,” Asian J. Allied Heal. Sci., vol. 7, no. 2, 2022.
[22]    A. Zaimi, S. A. Brahmi, and S. Afqir, “Nottingham prognostic index is an applicable prognostic tool in non-metastatic triple-negative breast cancer,” Asian Pacific J. cancer Prev. APJCP, vol. 20, no. 1, p. 59, 2019.
[23]    A. Pradhan, P. Paudyal, A. K. Sinha, and C. S. Agrawal, “Grading, staging and Nottingham prognostic index scoring of breast carcinoma,” J. Pathol. Nepal, vol. 7, no. 1, pp. 1078–1083, 2017.
[24]    Z. Ahmad, A. Khurshid, A. Qureshi, R. Idress, N. Asghar, and N. Kayani, “Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens,” Indian J. Pathol. Microbiol., vol. 52, no. 4, p. 477, 2009.
[25]    K. Gite and R. Chaudhari, “Histopathological Evaluation of Carcinoma Breast with Significance of Histological Grading and other Morphological Prognostic Factors at a Tertiary Health Care Institute,” MVP J. Med. Sci., pp. 185–193, 2018.
[26]    F. K. S. NIAZI and A. RABIA BASHARAT, “Role of Nottingham Prognostic Index Scoring in Determining Prognosis of Breast Carcinoma in Different Age Groups,” J. Fatima Jinnah Med. Univ., vol. 10, no. 1, 2016.
[27]    Z. M. Akhtar, R. Altaf, M. S. Amin, and S. Butt, “Relationship of Nottingham Prognostic Index with prognostic parameters of breast carcinoma,” Pakistan J. Med. Heal. Sci., vol. 16, no. 06, p. 26, 2022.
 
Al- Anbar Medical Journal
Volume 19, Issue 2
December 2023
Page 110-115
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