J Breast Cancer.  2017 Mar;20(1):65-73. 10.4048/jbc.2017.20.1.65.

A Prognostic Model for Patients with Triple-Negative Breast Cancer: Importance of the Modified Nottingham Prognostic Index and Age

• Kwon J
• Eom KY
• Koo TR
• Kim BH
• Kang E
• Kim SW
• Kim YJ
• Park SY
• Kim IA

• KMID: 2379400
• DOI: http://doi.org/10.4048/jbc.2017.20.1.65

Abstract

PURPOSE
Considering the distinctive biology of triple-negative breast cancer (TNBC), this study aimed to identify TNBC-specific prognostic factors and determine the prognostic value of the Nottingham Prognostic Index (NPI) and its variant indices.
METHODS
A total of 233 patients with newly diagnosed stage I to III TNBC from 2003 to 2012 were reviewed. We retrospectively analyzed the patients' demographics, clinicopathologic parameters, treatment, and survival outcomes. The NPI was calculated as follows: tumor size (cm)×0.2+node status+Scarff-Bloom-Richardson (SBR) grade. The modified NPI (MNPI) was obtained by adding the modified SBR grade rather than the SBR grade.
RESULTS
The median follow-up was 67.8 months. Five-year disease-free survival (DFS) and overall survival (OS) were 81.4% and 89.9%, respectively. Multivariate analyses showed that the MNPI was the most significant and common prognostic factor of DFS (p=0.001) and OS (p=0.019). Young age (≤35 years) was also correlated with poor DFS (p=0.006). A recursive partitioning for establishing the prognostic model for DFS was performed based on the results of multivariate analysis. Patients with a low MNPI (≤6.5) were stratified into the low-risk group (p<0.001), and patients with a high MNPI (>6.5) were subdivided into the intermediate (>35 years) and high-risk (≤35 years) groups. Age was not a prognostic factor in patients with a low MNPI, whereas in patients with a high MNPI, it was the second key factor in subdividing patients according to prognosis (p=0.023).
CONCLUSION
The MNPI could be used to stratify patients with stage I to III TNBC according to prognosis. It was the most important prognosticator for both DFS and OS. The prognostic significance of young age for DFS differed by MNPI.

Keyword

Age factors; Prognosis; Triple negative breast neoplasms

MeSH Terms

Age Factors
Biology
Demography
Disease-Free Survival
Follow-Up Studies
Humans
Multivariate Analysis
Prognosis
Retrospective Studies
Triple Negative Breast Neoplasms*

Figure

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  Figure 1 Survival outcomes according to modified Nottingham Prognostic Index (MNPI) scores. (A) Disease-free survival, (B) overall survival, and (C) distant metastasis-free survival.

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  Figure 2 Survival outcomes according to age at diagnosis. (A) Disease-free survival, (B) overall survival, and (C) distant metastasis-free survival.

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  Figure 3 Estimated disease-free survival by recursive partitioning analysis. (A) Low risk group; modified Nottingham Prognostic index (MNPI) ≤6.5, (B) intermediate risk group; MNPI >6.5 and age >35 years, and (C) high risk group; MNPI >6.5 and age ≤35 years.

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