Abstract:
Aim/Background: Lymph node stage (LNS), tumour size
and Nottingham grade (NG) are considered the most im portant prognostic factors of breast cancer (BC).However,
NG is not yet incorporated in the long used TNM staging
system which is meant to stratify BC patients into groups
that are prognostically and therapeutically similar. The
objective of this study was to assess the impact of NG on the
BC specific survival (BCSS) and recurrence free survival
(RFS) of operable BC patients.
Methods: This retrospective study included a consecutive
series of TNM stage I to III BC patients who had sought the
services of our unit from 2006 to 2012. These patients have
been treated according to standard protocols. Data were
collected through follow
up visits, clinic and laboratory records. Grading and scoring
of estrogen receptors (ER), progesterone receptors (PR) and
Her2 were done by a single investigator to eliminate inter observer variation. Kaplan-Meier and Cox-regression mod els were used in the survival analysis.
Results: There were 86 (12%) NG1, 338 (45%) NG2 and 318
(43%) NG3 patients with a median follow up of 39.5
months. Five-year BCSS was 94%-NG1, 80% - NG2 and
72% - NG3 ( p < 0.001). Five-year RFS was 86% - NG1, 75%
- NG2 and 67% - NG 3 (p = 0.001). Only the LNS ( p =
0.001) had an independent effect on the BCSS and RFS of
NG3 patients. LNS ( p = 0.001), PR (p = 0.004) and Her 2 ( p
< 0.001) independently affected the BCSS of NG 2 patients.
The same factors affected the RFS of NG2 patients except
the LNS. None of the factors considered for the multivariate
analysis had an effect on the BCSS or RFS of NG1
patients.NG1 patients in TNM stage I and II had 100% five year BCSS while it was 76.7% for stage III BCs. A significant
decrease in BCSS and RFS was seen with increase in NG in
the sub-groups of TNM stage III (p = 0.01 and 0.011),
tuours of 2cm-5cm (p = 0.035 and p = 0.013) and LNS3 (p
= 0.002 and p < 0.001) BC patients.
Conclusions: NG categorizes BC patients into three groups
with distinctly different survival outcomes. This difference
is retained in the subgroups; TNM stage III, tumours of
2cm-5cm and LNS3 BCs. NG1 tumours are a homogenous
group as none of the important prognostic factors affects
the BCSS or the RFS. Therefore sub-categorization of TNM
stage III by NG is suggested.
