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.