The
NOTTINGHAM PROGNOSTIC INDEX (NPI)
The NPI status was 1st published about 1992 as an
attempt at using some fairly objective parameters to determine the odds that a newly
diagnosed case of invasive ductal adenocarcinoma would benefit from adjuvant chemotherapy. By
whatever means, the status of the axillary lymph nodes must be determined at least as to
whether any nodes are positive for metastatic cancer (ALN+) or negative (ALN). If any
positive nodes, more details are needed. The studies looked at "overall survival" (OS) at 15
years post diagnosis. This grouping is just an initial categorization; many other
patientspecific factors are taken together to make a final decision.
SIZE: Decisions may have to be
made prior to having the whole tumor out and sizemeasurable. By whatever measure, the following
are the criteria for assignment of size points (such are finally, ultimately, assigned from the
pathology tissue studies):
 maximum tumor size
in centimeters:_____________times 0.2=________points.
TUMOR
GRADE:
 from 1 (better) to 3
(worse), by whatever system, the tumor grade=___________points
AXILLARY LYMPH NODE
STATUS:
Use one of the following scoring methods:
Classical scoring system:
 negative
nodes..............................................................................1
point
 positive nodes, low
axillary only...................................................2
points
 positive nodes,
internal mammary only.......................................2
points
 positive nodes,
axillary plus internal mammary..........................3
points
 positive nodes,
apical axillary node positivity.............................3
points
Alternative scoring system:
 negative
nodes...............................................................................1
point
 positive nodes, 1 to
3 positive......................................................2
points
 positive nodes, 4 or
more.............................................................3
points
CALCULATION
FORMULA:
NPI point sum= tumorsize pts [_____] plus grade pts
[_____]
plus lymph node pts [_____]=________total NPI
points
NPI DECISION GROUPS
Groups: 
80% OS @
15 yrs
if NPI <3.4
sum 
42% OS @
15 yrs
if NPI
3.45.4 sum 
13% OS @
15 yrs
if NPI
>5.4 sum 
Conclusions:
as to need for
adjuvant chemo. treatment 
need is doubtful 
MAY BENEFIT
with chemo. 
chemo needed 
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(initially posted: 24 Dec. 2000)
