Nottingham Prognostic Index (NPI) for Breast Cancer
Prognostic index for operable primary breast cancer (Haybittle 1982): NPI = 0.2 × tumour size (cm) + node stage + grade. Groups with 10-year breast-cancer-specific survival from Blamey 2007.
Score interpretation
10-year breast-cancer-specific survival 96% (Blamey 2007).
→ Standard local treatment (BCS + RT or mastectomy). Endocrine therapy if ER+. Chemotherapy generally not needed (consider Oncotype DX if borderline).
10-year breast-cancer-specific survival 93%.
→ Standard local treatment + adjuvant endocrine if ER+. Consider Oncotype DX / EndoPredict for chemotherapy decision in ER+/HER2−/N0.
10-year breast-cancer-specific survival 81%.
→ Adjuvant chemotherapy strongly considered in ER−/HER2+ disease. HER2-targeted therapy (trastuzumab ± pertuzumab) if HER2+. Endocrine if ER+.
10-year breast-cancer-specific survival 74%.
→ Multi-agent chemotherapy ± targeted (trastuzumab, pembrolizumab in TNBC per KEYNOTE-522) + endocrine if ER+. Consider neoadjuvant approach.
10-year breast-cancer-specific survival 55%.
→ Aggressive multi-modal therapy. Genetic testing (BRCA, PALB2) for PARPi eligibility. Consider trial enrolment. Long-term surveillance.
The worst NPI group — survival below the poor group.
→ Aggressive multi-modal therapy. Genetic testing (BRCA, PALB2) for PARPi eligibility. Consider trial enrolment. Long-term surveillance.
Interpretation bands for the NPI. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.