Ellis et al used the preoperative endocrine prognostic index (PEPI) to evaluate postmenopausal women with breast cancer. The authors are from multiple institutions in the United States and Europe.
Patient selection: postmenopausal woman with estrogen receptor (ER)-positive breast cancer
Outcomes: relapse-free survival (RFS) and breast cancer-specific survival (BCSS)
Parameters:
(1) pathologic T stage
(2) lymph node status
(3) Ki-67 index
(4) estrogen receptor (ER) status by Allred score
Parameter
Finding
Points RFS
Points BCSS
T stage
T1 or T2
0
0
T3 or T4
3
3
LN status
negative (N0)
0
0
positive
3
3
Ki-67 index
0 to 2.70%
0
0
2.71 to 7.30%
1
1
7.31 to 19.7%
1
2
19.8 to 53.1%
2
3
> 53.1%
3
3
ER status (Allred)
0 or 2
3
3
3 to 8
0
0
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score for relapse-free survival (RFS): 12
• maximum score for breast cancer-specific survival: 12
• A postmenopausal woman with Stage II or III estrogen receptor positive breast cancer and a PEPI score of 0 had a very low relapse rate after 5 years without chemotherapy.
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