Abstract
Simple SummaryBreast cancer is the most common tumor-related cause of death in women in Europe and worldwide. The aim of our retrospective study, including 6654 women, was on the one hand to verify the validity of the worldwide known Nottingham prognostic index (NPI), and on the other hand to create a new model with even more prognostic validity. Our newly developed Altona prognostic index (API) shows significantly superior outcome in calculating progression free survival. In contrast to the NPI, the API considers characteristics such as subtypes of breast cancer, as this disease is heterogenous involving different entities, and patient’s age. Evaluating progression free survival in different subgroups, our study shows that both these prognostic indices should only be applied on a patient collective that is ≤70 years old with first primary, unifocal, unilateral breast cancer that is of no special type (NST), estrogen receptor-positive and Her2-negative to get valid prediction data. Breast cancer is a heterogeneous disease representing a number of different histopathologic and molecular types which should be taken into consideration if prognostic or predictive models are to be developed. The aim of the present study was to demonstrate the validity of the long-known Nottingham prognostic index (NPI) in a large retrospective study (n = 6654 women with a first primary unilateral and unifocal invasive breast cancer diagnosed and treated between April 1996 and October 2018; median follow-up time of breast cancer cases was 15.5 years [14.9–16.8]) from a single pathological institution. Furthermore, it was intended to develop an even superior risk stratification model considering an additional variable, namely the patient’s age at the time of diagnosis. Heterogeneity of these cases was addressed by focusing on estrogen receptor-positive as well as Her2-negative cases and taking the WHO-defined different tumor types into account. Calculating progression free survival Cox-regression and CART-analysis revealed significantly superior iAUC as well as concordance values in comparison to the NPI based stratification, leading to an alternative, namely the Altona prognostic index (API). The importance of the histopathological tumor type was corroborated by the fact that when calculated separately and in contrast to the most frequent so-called “No Special Type” (NST) carcinomas, neither NPI nor API could show valid prognostic stratification.
Highlights
The incidence rate of breast cancer among women in Germany was 68,950 in 2016 and 18,600 women died of this disease in 2018
According to our inclusion criteria, the final cohort consisted of 6654 patients
The iAUC of the cox model was significantly better than the iAUC of the tree model and the Nottingham prognostic index (NPI) (Table 5)
Summary
The incidence rate of breast cancer among women in Germany was 68,950 in 2016 and 18,600 women died of this disease in 2018. Breast cancer represents the fifth rank of causes of death and is the most common tumor related cause after cardiovascular diseases. These figures correlate with epidemiologic data of breast cancer in Europe as well as worldwide [1,2,3]. The treatment of choice nowadays is breast-conserving therapy with the option of a neoadjuvant or adjuvant chemotherapy, radiotherapy and endocrine therapy. The aim of a therapy plan is a tailored treatment for breast cancer patients, a so-called “personalized medicine” with the best possible outcome for each individual patient [4,5,6,7,8,9]
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