Document Type : Original articles


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


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.


Main Subjects