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

Document Type: Research Articles


Service of Medical Oncology, University Hospital Mohammed VI-Oujda, Morocco.


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


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