PROGNOSTIC IMPLICATIONS OF THE NOTTINGHAM INDEX: CORRELATING WITH HORMONAL AND MOLECULAR MARKERS IN BREAST CANCER
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Keywords
Nottingham Index, Prognostic Implications, Hormonal Markers, Molecular Markers, Breast Cancer
Abstract
Background: The Nottingham Prognostic Index (NPI), developed in the 1980s, is a widely recognized tool used to assess breast cancer prognosis. It is based on three key parameters: tumor size, lymph node status, and histological grade. The NPI categorizes patients into distinct risk groups, facilitating tailored treatment strategies and informed clinical decision-making. The relationship between the NPI, hormonal receptors, and molecular subtypes raises essential questions about the potential for enhanced prognostic accuracy.
Material & Methods: Representative sections from both lumpectomy and mastectomy specimens were submitted for histopathological analysis. The pathological features evaluated included tumor size, histologic type, histologic grade, and lymph node status. The immunohistochemical status of ER, PR, HER2/Neu, and Ki-67 was assessed using standard techniques. Tumor grading was performed according to the Elston-Ellis modification of the Scarff-Bloom-Richardson (SBR) grading system. An H-score was utilized to evaluate ER and PR status, while HER2/Neu was graded based on the intensity of membrane staining. Subsequent to the assessment of pathological features, the Nottingham Prognostic Index (NPI) was calculated using a specific formula.
Results: The analysis of the Nottingham Prognostic Index (NPI) in relation to various pathological parameters revealed that only the modified Scarff-Bloom-Richardson (SBR) grade demonstrated a statistically significant association with NPI, achieving a significance level of 5% (p < 0.001). In contrast, there was no substantial agreement observed between the NPI and the values for estrogen receptor (ER), progesterone receptor (PR), HER-2/Neu, or Ki-67.
Conclusion: The findings suggest that reliance on the NPI alone may not provide a comprehensive understanding of patient prognosis. Therefore, integrating independent assessments of both the NPI and other prognostic markers is essential for enhancing the accuracy of prognostic evaluations and optimizing treatment strategies for breast cancer patients.
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Stuti Gupta
Assistant Professor, F H Medical College, Firozabad, UP
Nisha Chaudhary
Associate Professor, ASMC, Firozabad, UP
Saumya Bhagat
Assistant Professor, F H Medical College, Firozabad, UP
Ankur Goyal
Assistant Professor, ASMC, Firozabad, UP
Sonali Bandil
Associate Professor, ASMC, Firozabad, UP
Shubhangee Arya
Assistant Professor, ASMC, Firozabad, UP