![]() good, moderate and poor prognostic groups). Standardized published cut-offs (see Additional file 1: Appendix 1) are used to form prognostic categories within a population (e.g. The NPI categories are a linear combination of three prognostic factors: tumour size (maximum diameter in millimetres), histological grade (1- to 3-point scale) and lymph node staging (1- to 3-point scale). ![]() Decision-analytic models have a key role in the evaluation of new technologies when clinical trials are not likely to be feasible or timely in terms of producing robust evidence of the impact of introducing new programmes or changing existing programmes. In economic evaluation of new interventions, overall survival is a key input for decision-analytic models designed to quantify the incremental costs and benefits and inform if, and how, to allocate finite healthcare budgets towards new screening and management options. As well as providing prognostic estimates for individual patients, the NPI is useful in the context of economic evaluations. The NPI can be used to provide prognostic information by assigning individuals into prognostic categories and then applying the survival estimates from a previous cohort study. In clinical practice, NPI and related prognostic models have an important application for patients and clinicians to inform the decision of whether or not to undergo adjuvant chemotherapy following surgery, an early example of what is commonly called precision medicine. Although more advanced models have superseded NPI in some applications, it continues to have an active role in clinical practice and research. The Nottingham Prognostic Index (NPI) is a commonly used, clinically relevant and internationally validated system for classifying early and locally advanced breast cancer cases (TNM stages I, II, and III ) into three or more prognostic groups. The substantial differences between studies in the relationship between NPI categories and survival at 5 and 10 years poses challenges for use of this prognostic score in both clinical settings and in decision-analytic model-based economic evaluations. A high level of heterogeneity in survival estimates was evident with I 2 values in the range of 90 to 98%. Nineteen studies with sufficient data on overall survival were included in meta-analysis. An exploratory meta-analysis was conducted to describe survival estimates and assess between-study heterogeneity. Observational studies in women diagnosed with early and locally advanced breast cancer reporting overall survival by NPI category were identified using a systematic literature search. This review aimed to identify and summarize the estimated survival statistics from separate sources in the literature and to explore the extent of between-study heterogeneity in survival estimates. Estimates of survival for women diagnosed with early staged breast cancer are available based on stratification into prognostic categories defined using the Nottingham Prognostic Index (NPI).
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