Nottingham Prognostic Index in Triple-Negative Breast Cancer: a reliable prognostic tool?

The present study tested the effectiveness of the Nottingham Prognostic Index in stratifying breast cancer patients of different subtypes with special emphasis in a triple-negative breast cancer patient subset versus non- triple-negative breast cancer.We demonstrated that besides the fact that TNBC disseminate to axillary lymph nodes as frequently as luminal or HER2 tumours, we also showed that TNBC are larger in size compared with other subtypes and almost all grade 3. Additionally, survival curves demonstrated that these prognostic factors are equally important to stratify different survival outcomes in non-TNBC as in TNBC. We also showed that the NPI retains the ability to stratify and predict survival of TNBC patients.The importance of this study relies on the need of prognostication improvements on TNBC, showing, at a clinical standpoint, that Nottingham Prognostic Index is as a truthful prognostic tool in TNBC.Breast cancer comprises a complex and heterogeneous group of diseases at clinical, morphological and molecular levels [1-3]. It is clear that breast tumours of the same histological type show remarkably different clinical behaviour, which is probably a reflex of their distinct pattern of molecular aberrations [1,4]. Microarray technology has changed the way we understand breast cancer classification by looking towards a molecular-based approach instead the traditional morphology and histopathological-based system [5,6]. Pioneered by the Stanford group [6-9] and lately explored by several other groups, a new taxonomy for breast cancer based on expression profile has claimed that the morphological heterogeneity of breast cancer can be recapitulated and systematically classified at the transcriptomic level and into clinically meaningful groups [10-12]. Such studies have shown that the molecular profile of breast cancer present a systematic variation which allowed its differential identification into two distinct branches [11], the ER-positive branch, compri