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.
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.
Otsuki
Yoshiro
Y
Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
Shimizu
Shin-ichi
S
Suwa
Kaori
K
Yoshida
Masayuki
M
Kanzaki
Masao
M
Kobayashi
Hiroshi
H
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