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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.
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.
It 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.
The 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.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Showing the organ this term concerns: Breast cancer (all types).
Shares Grade, stage and receptor status: three different things on one breast report, Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage, Grade, Breast cancer (all types).
Shares Lymph node status (node-positive / node-negative), Invasive breast carcinoma of no special type (invasive ductal carcinoma), Invasive lobular carcinoma of the breast, Male breast cancer.
Shares Grade, stage and receptor status: three different things on one breast report, Grade, Breast cancer (all types), Triple-negative breast cancer (TNBC).
Shares Nottingham grade (breast cancer grade 1, 2 and 3), Grade, stage and receptor status: three different things on one breast report, Stage, Breast cancer (all types).
Shares Invasive breast carcinoma of no special type (invasive ductal carcinoma), Nottingham grade (breast cancer grade 1, 2 and 3), Invasive lobular carcinoma of the breast, Breast cancer (all types).
Shares Grade, stage and receptor status: three different things on one breast report, Male breast cancer, Breast cancer (all types), Triple-negative breast cancer (TNBC).
Shares Invasive breast carcinoma of no special type (invasive ductal carcinoma), Nottingham grade (breast cancer grade 1, 2 and 3), Breast cancer (all types), Triple-negative breast cancer (TNBC).
Shares Male breast cancer, Breast cancer (all types), Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer.