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Updated: Sep 17, 2026
Building Up a High-throughput Screening Platform to Assess the Heterogeneity of HER2 Gene Amplification in Breast Cancers
Published on: December 5, 2017
A Comparative Analysis of the Utility of Nottingham Prognostic Index and Ki-67 in Selecting ER-positive HER2-negative
Anita Golash1, Chandeena Roshanlall2, Jalal Kokan2
1Department of Breast Surgery, The Hillingdon Hospital NHS Foundation Trust, London, United Kingdom; Department of Breast Surgery, East Cheshire NHS Trust, Macclesfield, United Kingdom.
Background:
The Oncotype DX Recurrence Score (RS), Nottingham Prognostic Index (NPI), and Ki-67 are commonly used tools to assess recurrence risk and guide adjuvant treatment decisions in early breast cancer. This study evaluated the relationship between NPI, Ki-67, and Oncotype DX RS, and explored whether NPI and Ki-67 may help contextualize patient selection for genomic testing.
Patients:
Patients had ER-positive, HER2-negative breast cancer and were node-negative or had micrometastatic disease or 1 to 3 macrometastatic lymph nodes.
Methodology:
This retrospective observational study analyzed five years of breast cancer data from East Cheshire. Associations between NPI, Ki-67, and Oncotype DX RS were assessed using correlation analysis. Chemotherapy recommendations based on NPI, Ki-67, and Oncotype DX RS were compared. Statistical significance was defined as P < .05.
Results:
Among 195 patients (mean age 58.7 ± 9.4 years), chemotherapy was recommended in 62 (31.8%) based on Oncotype DX RS, with 52 (26.7%) ultimately receiving treatment. Ki-67 demonstrated a moderate correlation with Oncotype DX RS (r = 0.463, P < .001), while NPI showed a weaker but statistically significant correlation (r = 0.232, P = .001). Concordance with Oncotype DX RS was modest for both markers (51.8% for Ki-67 and 44.6% for NPI), indicating substantial discordance.
Conclusion:
NPI, using a threshold of 3.4 as recommended by NICE, may assist in identifying patients for whom Oncotype DX testing could be considered. Ki-67 may provide additional prognostic context when interpreted alongside NPI. These markers may contribute to broader risk stratification frameworks but should be viewed as complementary to genomic testing.
