Abstract:
Objective: We aimed to assess the impact of Nottingham grade (NG) on breast cancer specific survival
(BCSS) and recurrence free survival (RFS) of operable breast cancer (BC) patients presenting at
different TNM stages in view of assessing the value of NG in prognostication of breast cancer in
the Sri Lankan setting. Method: This retro-prospective study included a consecutive series of TNM
stage I to III BC patients presented to our unit from 2006 to 2012. Data were collected through
follow up visits, clinic and laboratory records. Grading and scoring of oestrogen receptors (ER),
progesterone receptors (PR) and human epidermal growth factor receptor 2 (Her2) expressions were
done by a single investigator. Kaplan-Meier and Cox-regression models were used in the survival
analysis. Results: A total of 742 (NG1-12%; NG2-45%; NG3-43%) patients with a median follow
up of 39.5 (range: 12 - 138) months were included. Five-year BCSS was 94%-NG1, 80%-NG2 and
72%-NG3 (p < 0.001). Five-year RFS was 86%-NG1, 75%-NG2 and 67%-NG3 (p = 0.001). Only
the lymph-node status (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 Her2 (p < 0.001) independently affected the BCSS
of NG2 patients. None of the factors considered had an effect on the BCSS/RFS of NG1 patients.
A significant decrease in BCSS and RFS was seen with an increase in NG in the sub-group of TNM
stage III (p = 0.01 and 0.011). Conclusion: NG categorizes BC patients into prognostic groups with
distinctly different survival outcomes. Sub-categorization of TNM stage III by NG is suggested.
