Balslev I, Axelsson C K, Zedeler K, Rasmussen B B, Carstensen B, Mouridsen H T
Department of Tumour Endocrinology, Danish Cancer Society, Copenhagen.
Breast Cancer Res Treat. 1994;32(3):281-90. doi: 10.1007/BF00666005.
In primary, operable breast cancer, the Nottingham Prognostic Index (NPI) based on tumour size, lymph node stage and histological grade can identify three prognostic groups (PGs) with 10-year survival rates of 83%, 52%, and 13%. With the aim of defining a subset of patients having so good prognosis that adjuvant therapy can be withhold, the NPI was applied to a Danish population-based study group comprising 9,149 patients. As opposed to the British study, we used conventional axillary lymph-node staging. Histological grading was in both studies done by means of a similar slight modification of the Bloom and Richardson procedure, but in the Danish study only ductal carcinomas were graded. The 10-year crude survival was 68.1% for 4,791 patients with tumour size < or = 2 cm and 70.0% for 2,900 patients with grade I tumours. For 4,761 node-negative patients, the 10-year survival was also 70.0%, the expected survival being 89.3%. The relative mortality (observed:expected) was even at 10 years 2.1 demonstrating that more than 10 years observation time is necessary to estimate cumulated mortality. By application of the NPI, the Danish good PG comprising 27.3% of the patients had a 10-year survival of 79.0%. Thus, the index defined a subset with better survival than could be defined individually by each of its three components, but it did not succeed in defining a subset with survival similar to the expected; additional prognostic factors are therefore needed. The somewhat poorer survival of the Danish good PG may be ascribed to the British inclusion of non-ductal carcinomas, to interobserver variation present only in the Danish study, and to poorer expected survival of the Danish patients. The 10-year survival of the Danish moderate PG and poor PG was 56% and 25%, respectively. These improved survival rates are attributed to the administration of adjuvant therapies. There were virtually no node-positive patients in the good PG and no node-negative patients in the poor PG. Patients should therefore still be stratified initially by lymph-node status, but tumour size and histological grade are significant prognostic factors primarily within the node-negative group, and they should be included in future prognostication procedures.
在原发性可手术乳腺癌中，基于肿瘤大小、淋巴结分期和组织学分级的诺丁汉预后指数（NPI）可识别出三个预后组（PGs），其10年生存率分别为83%、52%和13%。为了确定预后非常好以至于可以不进行辅助治疗的患者亚组，NPI被应用于一个基于丹麦人群的研究组，该研究组包括9149名患者。与英国的研究不同，我们采用了传统的腋窝淋巴结分期。两个研究中的组织学分级都是通过对Bloom和Richardson方法进行类似的轻微修改来完成的，但在丹麦的研究中只对导管癌进行分级。4791名肿瘤大小≤2 cm的患者的10年粗生存率为68.1%，2900名I级肿瘤患者的10年粗生存率为70.0%。对于4761名淋巴结阴性的患者，10年生存率也是70.0%，预期生存率为89.3%。相对死亡率（观察值：预期值）在10年时甚至为2.1，这表明需要超过10年的观察时间来估计累积死亡率。通过应用NPI，丹麦预后良好的PG组（占患者的27.3%）的10年生存率为79.0%。因此，该指数定义了一个生存率比其三个组成部分单独定义的更好的亚组，但未能成功定义一个生存率与预期相似的亚组；因此需要额外的预后因素。丹麦预后良好的PG组生存率略低可能归因于英国纳入了非导管癌、仅在丹麦研究中存在的观察者间差异以及丹麦患者较差的预期生存率。丹麦预后中等的PG组和预后较差的PG组的10年生存率分别为56%和25%。这些生存率的提高归因于辅助治疗的应用。预后良好的PG组几乎没有淋巴结阳性患者，预后较差的PG组几乎没有淋巴结阴性患者。因此，患者最初仍应按淋巴结状态进行分层，但肿瘤大小和组织学分级主要是淋巴结阴性组中的重要预后因素，应纳入未来的预后评估程序中。
