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Traditionally, Nottingham prognostic index (NPI) informed prognosis in patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative, node negative (ER+/HER2-/LN-) breast cancer. At present, OncotypeDX© Recurrence Score (RS) predicts prognosis and response to adjuvant chemotherapy (AC). To compare NPI and RS for estimating prognosis in ER + breast cancer. Consecutive patients with ER+/HER2-/LN- disease were included. Disease-free (DFS) and overall survival (OS) were determined using Kaplan-Meier and Cox regression analyses. 1471 patients met inclusion criteria. The mean follow-up was 110.7months. NPI was calculable for 1382 patients: 19.8% had NPI≤2.4 (291/1471), 33.0% had NPI 2.41–3.4 (486/1471), 30.0% had NPI 3.41–4.4 (441/1471), 10.9% had NPI 4.41–5.4 (160/1471), and 0.3% had NPI>5.4 (4/1471). In total, 329 patients underwent RS (mean RS: 18.7) and 82.1% had RS < 25 (270/329) and 17.9% had RS ≥ 25 (59/329). Using multivariable Cox regression analyses (n = 1382), NPI independently predicted DFS (Hazard ratio (HR): 1.357, 95% confidence interval (CI): 1.140–1.616, P < 0.001) and OS (HR: 1.003, 95% CI: 1.001–1.006, P = 0.024). When performing a focused analysis of those who underwent both NPI and RS (n = 329), neither biomarker predicted DFS or OS. Using Kaplan Meier analyses, NPI category predicted DFS (P = 0.008) and (P = 0.026) OS. Conversely, 21-gene RS group failed to predict DFS (P = 0.187) and OS (P = 0.296). In our focused analysis, neither NPI nor RS predicted survival outcomes. However, in the entire series, NPI independently predicted both DFS and OS. On the 40th anniversary since its derivation, NPI continues to provide accurate prognostication in breast cancer, outperforming RS in the current study. • NPI outperformed RS for estimating prognosis in ER + disease. • Neither RS nor NPI independently predicted survival in focused analysis. • NPI remains clinically relevant, even in the molecular era. [ABSTRACT FROM AUTHOR]

Human epidermal growth factor receptor-2 (HER2) is overexpressed in 20–25% of breast cancers. Complete eradication of disease following neoadjuvant therapies and chemotherapy has been referred to as pathological complete response (pCR). To determine clinicopathological predictors of pCR to neoadjuvant therapies and to evaluate pCR as a surrogate to enhanced survival. Consecutive female patients with HER2 positive (HER+) breast cancer managed surgically in a single institution between 2005 and 2015 were included. Descriptive statistics and binary logistic regression were used to determine predictors of pCR. Appraisal of pCR as a predictor of survival was performed using Kaplan-Meier curves and Cox regression analysis. 451 patients were included with a mean age of 56.6 ± 13.4 years (range 23–95). Disease-free (DFS) and overall survival (OS) was 82.3% (371/451) and 82.6% (376/451) respectively with a median follow-up of 108.0 months (range 3–184.0). 118 were treated in the neoadjuvant setting (26.2%): tumour size <50 mm (Odds Ratio (OR): 12.156, P = 0.023) and progesterone receptor negativity (OR: 2.762, P = 0.008) independently predicted breast pCR, while ductal carcinoma (OR: 3.203, P = 0.030) and grade 3 disease (OR: 2.788, P = 0.018) predicted axillary pCR. Both breast and axillary pCR predicted enhanced DFS (Hazard Ratio (HR): 0.470 & HR: 0.449) and OS (HR: 0.383 & HR: 0.307). Axillary pCR independently predicted improved OS (HR: 0.326). pCR is sensitive biomarker and surrogate to survival outcomes in HER2+ breast cancer. Patients likely to achieve pCR may be predicted from traditional clinicopathological characteristics and molecular parameters. • Clinicopathological data predict patients who achieve pCR in HER2+ breast cancer. • pCR is a sensitive biomarker of survival in HER2 positive breast cancer. • Patients achieving pCR have reduced risk of breast cancer recurrence and mortality. • pCR can aid patient prognostication in the era of personalised medicine. [ABSTRACT FROM AUTHOR]

Background Z0011 study suggests patients with minimal disease do not require axillary clearance. Exclusions include T3 tumours, mastectomy or neoadjuvant treatment. This study assessed the utility of pre-operative US-guided core biopsy of axillary nodes and its correlation with nodal macrometastases. Methods 247 women with breast cancer outside Z0011 criteria were reviewed retrospectively. Sensitivity and specificity of pre-operative axillary ultrasound and core biopsy compared to final histology was assessed by contingency tables. Results 75/247 patients had macrometastases. Ultrasound-axilla was 72% sensitive and 77% specific in predicting macrometastasis. The positive (PPV) and negative predictive value (NPV) was 58% and 86.4% respectively. Core-biopsy of axilla node, was 92.6% sensitive and 66.7% specific in detecting macrometastasis. PPV and NPV 79.4% and 86.7% respectively. Conclusion Positive pre-operative ultrasound-guided core biopsy accurately predicts macroscopic involvement of axillary nodes. Selected patients outside Z0011 parameters can proceed to axillary clearance without sentinel node biopsy or risking overtreatment. [ABSTRACT FROM AUTHOR]

Current guidelines do not recommend locoregional surgery for Stage IV breast cancer at presentation despite some studies suggesting a survival benefit. We aimed to assess outcomes in patients with Stage IV breast cancer who underwent surgery. In a cohort study of all Stage IV breast cancers diagnosed at our tertiary-referral specialist centre between 2006 and 2012, we assessed patient survival in the context of demographics, histopathology, metastatic burden, and type of surgery performed. One hundred and nine patients were included; 52 underwent surgery. Patients in the surgery group had longer 5-year-survival ( p = 0.003). Survival was also significantly longer in those with just one site of metastatic disease ( p < 0.001). Patients with axillary cytology positive for regional metastases were less likely to proceed to surgery. Locoregional surgery does confer a survival advantage in Stage IV breast cancer. Assessment of preoperative axillary cytology may preclude some patients from proceeding to potentially beneficial locoregional surgery. [ABSTRACT FROM AUTHOR]