Skip to main content

Nottingham prognostic index plus: validation of a clinical decision making tool in breast cancer in an independent series

Green, Andrew R., Soria, Daniele, Stephen, Jacqueline, Powe, Desmond G., Nolan, Christopher C., Kunkler, Ian, Thomas, Jeremy, Kerr, Gillian R., Jack, Wilma, Cameron, David, and others. (2015) Nottingham prognostic index plus: validation of a clinical decision making tool in breast cancer in an independent series. The Journal of Pathology: Clinical Research, 2 (1). pp. 32-40. E-ISSN 2056-4538. (doi:10.1002/cjp2.32) (KAR id:79606)

PDF Author's Accepted Manuscript
Language: English

Download (977kB) Preview
[thumbnail of NPI+ validation edinburgh paper.pdf]
This file may not be suitable for users of assistive technology.
Request an accessible format
Official URL


The Nottingham Prognostic Index Plus (NPI+) is a clinical decision making tool in breast cancer (BC) that aims to provide improved patient outcome stratification superior to the traditional NPI. This study aimed to validate the NPI+ in an independent series of BC. 885 primary early stage BC cases from Edinburgh were semi-quantitatively assessed for 10 biomarkers [Estrogen Receptor (ER), Progesterone Receptor (PgR), cytokeratin (CK) 5/6, CK7/8, epidermal growth factor receptor (EGFR), HER2, HER3, HER4, p53, and Mucin 1]

Groups (PGs) were assigned for each class using bespoke NPI-like formulae, previously developed in each NPI+ biological class of the Nottingham series, utilising

The NPI+ biomarker panel classified the Edinburgh series into seven biological classes similar to the Nottingham series (p>0.01). The biological classes were significantly associated with patient outcome (p<0.001). PGs were comparable in predicting patient outcome between series in Luminal A, Basal p53 altered, HER2+/ER+ tumours (p>0.01). The good PGs were similarly validated in Luminal B, Basal p53 normal, HER2+/ER- tumours and the poor PG in the Luminal N class (p>0.01). Due to small patient numbers assigned to the remaining PGs, Luminal N, Luminal B, Basal p53 normal and HER2+/ER- classes could not be validated. This study demonstrates the reproducibility of NPI+ and confirmed its prognostic value in an independent cohort of primary breast cancer. Further validation in large randomised controlled trial material is warranted.

Item Type: Article
DOI/Identification number: 10.1002/cjp2.32
Uncontrolled keywords: breast cancer; classification; prognostic index; molecular; clinical; outcome
Subjects: Q Science > QA Mathematics (inc Computing science)
Divisions: Divisions > Division of Computing, Engineering and Mathematical Sciences > School of Computing
Depositing User: Daniel Soria
Date Deposited: 17 Jan 2020 15:24 UTC
Last Modified: 16 Feb 2021 14:10 UTC
Resource URI: (The current URI for this page, for reference purposes)
Soria, Daniele:
  • Depositors only (login required):


Downloads per month over past year