Supplementary Material for: Predicting survival of patients with nonmetastatic breast cancer based on fibrinogen-to-albumin ratio and lymphocyte-to-monocyte ratio: A nomogram-based assessment

Background: Parameters of systemic inflammation have received attention as prognostic surrogates in various malignant tumors. Fibrinogen-to-albumin ratio (FAR) and lymphocyte-to-monocyte ratio (LMR) correlate with tumor growth and dissemination. We aimed to bring the combination of FAR and LMR (FAR-LMR) together to establish novel nomograms for survival and recurrence in nonmetastatic breast cancer patients. Methods: We retrospectively recruited 461 female patients with nonmetastatic breast cancer from January 2011 to December 2013 in our hospital and randomly assigned them into the training cohort (N=318) and the validation cohort (N=143). The potential predictive factors for overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were assessed by Cox proportional hazards models and log-rank test. Results: Elevated FAR was associated with poor OS (P < 0.001) and DMFS (P = 0.02), whereas increased LMR was associated with satisfactory OS (P = 0.01) and LRFS (P = 0.03). High FAR combined with low LMR was associated with less favorable OS (P = 0.001), LRFS (P = 0.005), and DMFS (P = 0.003) Based on multivariate analysis, FAR-LMR, tumor size, lymph node metastasis, age and pathologic status contributed to prognostic nomograms of OS, DMFS and LRFS. Nomograms presented exceptional performance for 3-, 5- and 8-year OS, DMFS and LRFS prediction compared with clinical TNM stage. The C-index was significantly higher than that of TNM stage, either of FAR or LMR (3-year: 0.709 vs 0.621 vs 0.544 vs 0.641, 5-year: 0.761 vs 0.597 vs 0.605 vs 0.677, 8-year: 0.84 vs 0.62 vs 0.539 vs 0.623). Conclusions: We developed and validated a convenient predictive model for the survival outcomes in patients with nonmetastatic breast cancer. The nomograms can be utilized as auxiliary tools to provide prognostic information.背景：全身炎症参数作为多种恶性肿瘤的预后替代指标已受到广泛关注。纤维蛋白原与白蛋白比值（Fibrinogen-to-albumin ratio, FAR）以及淋巴细胞与单核细胞比值（lymphocyte-to-monocyte ratio, LMR）与肿瘤生长及播散密切相关。本研究旨在联合FAR与LMR构建FAR-LMR评分，为非转移性乳腺癌患者的生存与复发情况建立新型列线图预测模型。 方法：本研究回顾性纳入2011年1月至2013年12月于我院就诊的461例非转移性乳腺癌女性患者，采用随机分组法将其分为训练队列（N=318）与验证队列（N=143）。采用Cox比例风险模型与log-rank检验，对总生存期（overall survival, OS）、局部区域无复发生存期（locoregional recurrence-free survival, LRFS）以及远处无转移生存期（distant metastasis-free survival, DMFS）的潜在预测因素进行分析。 结果：FAR升高与较差的OS（P<0.001）及DMFS（P=0.02）相关，而LMR升高则与更佳的OS（P=0.01）及LRFS（P=0.03）相关。高FAR联合低LMR与更差的OS（P=0.001）、LRFS（P=0.005）及DMFS（P=0.003）显著相关。多因素分析结果显示，FAR-LMR、肿瘤大小、淋巴结转移、年龄及病理状态均是OS、DMFS与LRFS预后列线图的独立影响因素。相较于临床TNM分期，本研究构建的列线图在3年、5年及8年OS、DMFS与LRFS预测中均展现出优异的性能。其C-index显著高于TNM分期、单独FAR或单独LMR（3年：0.709 vs 0.621 vs 0.544 vs 0.641；5年：0.761 vs 0.597 vs 0.605 vs 0.677；8年：0.84 vs 0.62 vs 0.539 vs 0.623）。 结论：本研究构建并验证了一款用于非转移性乳腺癌患者生存结局预测的便捷预测模型，该列线图可作为辅助工具为临床提供预后评估信息。