The Use of Nottingham Prognostic Index to Predict the Survival and Prognosis of Iraqi Females with Breast Carcinoma
Abstract
ABSTRACT
Background: Breast cancer is the most frequently diagnosed malignancy among females in Iraq and worldwide. The clinical course varies from patient to patient and tumors of the same histological type show remarkably different tumor behavior. Other parameters are needed to predict the behavior of the tumor and to help the treating physician in choosing the best therapeutic options. Prognostic factors can be used to predict disease-free period, survival and prognosis
Objectives: To study the correlation between the Nottingham Prognostic Index (NPI) value and the disease-free period, overall survival and prognosis of Iraqi patients with breast cancer.
Methods: Starting from Jan 1st 2007 to Jan 1st 2013, the NPI value was calculated for all patients diagnosed and treated as breast carcinoma at al-Yarmouk Teaching Hospital. Detailed clinical, investigative and therapeutic data for these patients were obtained. They were followed closely for average of 5 years periods with repeated clinical examinations and investigations. All were sent for adjuvant therapy. Recurrences, metastases, morbidity and mortality were documented
Results: Forty-one patients out of 58 patients fulfilled the criteria for the study. Breast malignancy was confirmed by FNA cytology and excisional biopsy. All were subjected to surgery mainly in the form of modified radical mastectomy (66%). The size of the tumor was < 2 cm in 41.4% and 2-5 cm in 36.6%. Regarding nodal status, 25% were N1, 50% N2 and 12.5% N3. The majority of the tumors were infiltrative duct carcinoma (70.7%). Most of the tumors were grade II (68.3%). NPI were calculated for all patients. Patients with low NPI value (2.4-3.4) had a mean disease-free period of 2.2 years and excellent prognosis. Those with a higher NPI value (3.4-5.4) had a mean disease-free period of 1.3 years and a good to moderate prognosis. Patients with NPI >5.4 had poor prognosis.
Conclusions: Nottingham prognostic index is easy to use, practical and reliable. It can help in predicting the disease-free period, survival and prognosis in patients with breast carcinoma.
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