{"entity":{"id":"nottingham-prognostic-index","kind":"term","name":"Nottingham Prognostic Index (NPI), and PREDICT","aka":["NPI","Nottingham Prognostic Index","Nottingham index","prognostic index breast","PREDICT","PREDICT tool","NHS Predict","Predict breast","Adjuvant! Online"],"tldr":"One number that puts a breast cancer's size, its node status and its grade together, because the stage on its own leaves grade out. Score under 2.4 is the excellent group; 5.4 or above is the poor group. PREDICT is the modern web tool that does the same job and adds the receptors, age and the benefit of each treatment.","summary":"The index is deliberately simple: NPI = grade (1 to 3) + node stage (1 to 3) + 0.2 times the invasive tumour size in centimetres. Node stage is 1 for negative nodes, 2 for one to three positive axillary nodes or an internal mammary node alone, including micrometastatic disease, and 3 for more than three positive nodes, or the apical node, or a low axillary node and an internal mammary node together. Size is the largest invasive tumour; in multifocal disease the largest mass is used, unless the grades of the separate lesions differ, when the one giving the highest score is reported. Scores run from 2.01 to above 7, and the dataset in force bands them as excellent below 2.4, good from 2.4 to below 3.4, moderate 1 from 3.4 to below 4.4, moderate 2 from 4.4 to below 5.4, and poor at 5.4 and above, with poor subdividing at 6.4 into poor and very poor.\n\nIt was built by looking for what actually predicted outcome. Nine factors were tested in 387 patients in 1982 and only three survived multivariate analysis, size, node stage and grade; the index was then validated prospectively in 320 patients and applied to the first 1,629 patients of the Nottingham series aged up to 70. In that cohort the good prognosis group was 29 percent of patients with 80 percent fifteen-year survival, the moderate group 54 percent with 42 percent, and the poor group 17 percent with 13 percent, against 83 percent fifteen-year survival in an age-matched female population (Galea 1992). The good group's outcome sitting within a few points of the general population's is the whole point of the index: it identifies the people for whom the cancer is not what will shorten their life.\n\nThe index is not applicable after neoadjuvant chemotherapy, in locally advanced disease, in metastatic disease or in recurrence, because it was derived in patients who had surgery first. For everyone else it has largely been replaced in the clinic by PREDICT, a model built on UK cohorts that adds age, oestrogen receptor and HER2 status, Ki-67 and the mode of detection, and that estimates not only survival but the extra benefit of endocrine therapy, chemotherapy and HER2-directed treatment. NICE NG101 recommendation 1.6.4 asks clinicians to use PREDICT to estimate prognosis and the absolute benefits of adjuvant therapy for women with invasive breast cancer, and 1.6.5 lists where it is less accurate: women under 30 with oestrogen receptor-positive disease, women aged 70 and over, tumours larger than 50 mm, men, in whom it has not been validated at all, and ethnic groups that may have been under-represented in the validation.","asOf":"2026-09-25","wikipedia":"https://en.wikipedia.org/wiki/Nottingham_Prognostic_Index","links":[{"label":"Royal College of Pathologists G148: dataset for histopathological reporting of breast disease in surgical excision specimens of breast cancer, version 3, November 2024 (full review due November 2026)","url":"https://www.rcpath.org/resourceLibrary/g148-dataset-for-histopathological-reporting-of-breast-disease-in-surgical-excision-specimens-of-breast-cancer.html"},{"label":"Galea, Blamey, Elston and Ellis, Breast Cancer Research and Treatment 1992;22:207 to 219: the Nottingham Prognostic Index in primary breast cancer","url":"https://doi.org/10.1007/bf01840834"},{"label":"NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025)","url":"https://www.nice.org.uk/guidance/ng101/chapter/recommendations"}],"tags":[],"related":["lymph-node-status","tumour-grade","cancer-stage","prognosis"],"cancers":["breast-cancer","invasive-breast-carcinoma-no-special-type","breast-hr-positive","invasive-lobular-carcinoma","male-breast-cancer"],"sections":["diagnostics"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["nottingham-grade","grade-stage-receptor-breast","breast-tumour-size-on-the-report","lymph-node-status","tnm-breast-cancer-editions"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Why two tools for one question. The index was designed to be worked out on paper from three numbers a pathologist already reports, and it still is: the RCPath dataset lists grade partly because it feeds the index. PREDICT needs a computer and more inputs, and in exchange it answers the question a patient is actually asking, which is not how likely am I to survive but how much difference does each treatment make. Neither is a personal certainty; both are averages over people who looked similar on paper."],"category":"Clinical"},"route":"/terms/nottingham-prognostic-index/","neighbours":{"term":[{"id":"tumour-grade","kind":"term","name":"Grade","route":"/terms/tumour-grade/"},{"id":"grade-stage-receptor-breast","kind":"term","name":"Grade, stage and receptor status: three different things on one breast report","route":"/terms/grade-stage-receptor-breast/"},{"id":"lymph-node-status","kind":"term","name":"Lymph node status (node-positive / node-negative)","route":"/terms/lymph-node-status/"},{"id":"nottingham-grade","kind":"term","name":"Nottingham grade (breast cancer grade 1, 2 and 3)","route":"/terms/nottingham-grade/"},{"id":"prognosis","kind":"term","name":"Prognosis","route":"/terms/prognosis/"},{"id":"cancer-stage","kind":"term","name":"Stage","route":"/terms/cancer-stage/"},{"id":"breast-tumour-size-on-the-report","kind":"term","name":"Tumour size on a breast report, and why it differs from the scan","route":"/terms/breast-tumour-size-on-the-report/"},{"id":"tnm-breast-cancer-editions","kind":"term","name":"Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage","route":"/terms/tnm-breast-cancer-editions/"}],"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"invasive-breast-carcinoma-no-special-type","kind":"cancer","name":"Invasive breast carcinoma of no special type (invasive ductal carcinoma)","route":"/cancers/invasive-breast-carcinoma-no-special-type/"},{"id":"invasive-lobular-carcinoma","kind":"cancer","name":"Invasive lobular carcinoma of the breast","route":"/cancers/invasive-lobular-carcinoma/"},{"id":"male-breast-cancer","kind":"cancer","name":"Male breast cancer","route":"/cancers/male-breast-cancer/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}]}}