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Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer

Rakha, E.A., Soria, D., Green, A.R., Lemetre, C., Powe, D.G., Nolan, C.C., Garibaldi, J.M., Ball, G., Ellis, I.O. (2014) Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer. British Journal of Cancer, 110 . pp. 1688-1697. ISSN 0007-0920. E-ISSN 1532-1827. (doi:10.1038/bjc.2014.120) (KAR id:76751)

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Background: Current management of breast cancer (BC) relies on risk stratification based on well-defined clinicopathologic factors. Global gene expression profiling studies have demonstrated that BC comprises distinct molecular classes with clinical relevance. In this study, we hypothesised that molecular features of BC are a key driver of tumour behaviour and when coupled with a novel and bespoke application of established clinicopathologic prognostic variables can predict both clinical outcome and relevant therapeutic options more accurately than existing methods.

Methods: In the current study, a comprehensive panel of biomarkers with relevance to BC was applied to a large and well-characterised series of BC, using immunohistochemistry and different multivariate clustering techniques, to identify the key molecular classes. Subsequently, each class was further stratified using a set of well-defined prognostic clinicopathologic variables. These variables were combined in formulae to prognostically stratify different molecular classes, collectively known as the Nottingham Prognostic Index Plus (NPI+). The NPI+ was then used to predict outcome in the different molecular classes.

Results: Seven core molecular classes were identified using a selective panel of 10 biomarkers. Incorporation of clinicopathologic variables in a second-stage analysis resulted in identification of distinct prognostic groups within each molecular class (NPI+). Outcome analysis showed that using the bespoke NPI formulae for each biological BC class provides improved patient outcome stratification superior to the traditional NPI.

Conclusion: This study provides proof-of-principle evidence for the use of NPI+ in supporting improved individualised clinical decision making.

Item Type: Article
DOI/Identification number: 10.1038/bjc.2014.120
Uncontrolled keywords: breast cancer; classification; prognostic index; molecular; clinical; outcome
Subjects: R Medicine
Divisions: Divisions > Division of Computing, Engineering and Mathematical Sciences > School of Computing
Depositing User: Daniel Soria
Date Deposited: 24 Sep 2019 09:59 UTC
Last Modified: 16 Feb 2021 14:07 UTC
Resource URI: (The current URI for this page, for reference purposes)
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