title: Which is the better pathological prognostic factor, the Nottingham histological grade or the Japanese nuclear grade? A large scale study with a long-term follow-up.
abstract: BACKGROUND
  We compared the Nottingham histological grade (H-grade) and the Japanese nuclear grade (N-grade) to select the better prognostic factor for breast cancers.
  
  
  METHODS
  The series included 1786 patients with breast cancers with the exception of non-invasive and stage 4 cancers. They were classified according to the H- and N-grade. We analyzed their survival curves and also performed multivariate Cox regression analyses.
  
  
  RESULTS
  According to the H-grade classification, 476 cases were grade 1, 647 cases were grade 2 and 663 cases were grade 3. According to the N-grade, 381 cases were grade 1, 215 cases were grade 2, and 1129 cases were grade 3. In the survival curves of those cases with lymph node metastases (N+) and recurrent cases, there were statistically significant differences in different categories of the H-grades, but not in the N-grades. The survival curves of all the cases and those cases without lymph node metastases (N-) always exhibited statistically significant differences. According to the 2003 St Gallen consensus, the N- group was classified as a minimal risk and an average risk groups. Both H- and N-grade exhibited statistically significant differences between the minimal risk and the average risk groups in the disease-free survival. The multivariate analyses proved that the H-grade was a statistically significant prognostic factor in all the cases and N+ group, but the N-grade was not significant in any of the studies.
  
  
  CONCLUSIONS
  The H-grade is clearly proved to be a more significant prognostic factor for wider stage cases than the N-grade.
authors.affiliation: Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Otsuki
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Shimizu
authors.forename: Kaori
authors.initials: K
authors.lastname: Suwa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yoshida
authors.forename: Masao
authors.initials: M
authors.lastname: Kanzaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000648:ultrastructure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis