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Article Open Access

Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study

  • Authors:
    • Boxiang Zhang
    • Kuan Wang
    • Maihemuti Aishanjiang
    • Fang Lan
    • Binlin Ma
  • View Affiliations / Copyright

    Affiliations: Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Oncology, Urumqi, Xinjiang Uygur Autonomous Region 830011, P.R. China, The Clinical Medical Research Center of Breast and Thyroid Tumor in Xinjiang, Urumqi, Xinjiang Uygur Autonomous Region 830011, P.R. China
    Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 125
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    Published online on: February 2, 2026
       https://doi.org/10.3892/ol.2026.15478
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Abstract

Serum albumin (ALB) and the lymphocyte‑to‑monocyte ratio (LMR) are established inflammation‑ and nutrition‑related biomarkers associated with tumor progression. Their combined prognostic value in triple‑negative breast cancer (TNBC) has not been fully defined. Therefore, the present study aimed to develop and demonstrate a lymphocyte‑albumin‑monocyte index (LANI) that integrates ALB and LMR for prognostic assessment in TNBC. A retrospective cohort of 166 surgically treated patients with TNBC was analyzed and divided into training (n=116) and validation (n=50) cohorts. Receiver operating characteristic analysis yielded optimal thresholds of 39.35 g/l for ALB and 2.526 for LMR, which were rounded to clinical cutoffs of 40 g/l and 2.97. Patients were categorized into three LANI groups, namely LANI=0 (ALB <40 g/l and LMR <2.97), LANI=1 (either indicator above the cutoff) and LANI=2 (both indicators above the cutoff). Multivariate Cox analysis demonstrated that tumor stage, histologic grade and LANI were independent predictors of overall survival, with a LANI value of 2 indicating markedly reduced mortality risk (hazard ratio=0.03; 95% CI: 0.002‑0.46; P=0.012). A nomogram incorporating these factors showed strong discrimination, good calibration and a meaningful clinical net benefit across both cohorts. Overall, the LANI provides a simple, reproducible and cost‑effective biomarker that enhances prognostic stratification and supports individualized management in TNBC.

View Figures

Figure 1

Prognostic relevance of ALB and LMR
in patients with triple-negative breast cancer. (A) ROC curve
analysis for serum ALB and LMR, showing their predictive accuracy
for OS, with optimal cut-off values of 39.35 g/l for ALB
(AUC=0.757) and 2.526 for LMR (AUC=0.634). These ROC-derived
cut-offs closely approximated the prespecified clinical thresholds
for ALB and LMR (40.0 g/l and 2.97, respectively) used in the LANI
classification to enhance clinical applicability. RCS plots
illustrating the continuous relationship between (B) ALB, (C) LMR
and OS risk. ALB, albumin; LMR, lymphocyte-to-monocyte ratio; ROC,
receiver operating curve; AUC, area under the curve; LANI,
lymphocyte-albumin-monocyte index; OS, overall survival.

Figure 2

Development and validation of the
LANI prognostic model in patients with triple-negative breast
cancer. (A) ROC curve analysis evaluating the predictive
performance of the LANI model for OS. The LANI model achieved the
highest AUC (0.792), indicating improved prognostic accuracy. (B)
Kaplan-Meier survival curves stratified by LANI scores, showing
that patients with LANI=2 exhibited significantly improved OS
compared with those with LANI ≤1 (log-rank P<0.001). Numbers at
risk are also shown (LANI ≤1, n=59; LANI=2, n=57). LANI,
lymphocyte-albumin-monocyte index; ROC, receiver operating curve;
AUC, area under the curve; OS, overall survival.

Figure 3

Construction and calibration of the
prognostic nomogram for patients with triple-negative breast
cancer. (A) Nomogram integrating T stage, histologic grade and LANI
to predict 1-, 3- and 5-year overall survival. (B) Brier
score-based calibration plot at 1 year. (C) Brier score-based
calibration plot at 3 years. (D) Brier score-based calibration plot
at 5 years. (E) Brier score-based calibration plot at 1 year in the
validation cohort. (F) Brier score-based calibration plot at 3
years in the validation cohort. (G) Brier score-based calibration
plot at 5 years in the validation cohort. (H) Calibration curve
comparing predicted and observed survival probabilities, revealing
a close concordance between predicted and observed survival,
suggesting good calibration performance of the model. T stage,
tumor stage; LANI, lymphocyte-albumin-monocyte index.

Figure 4

DCA of the LANI-based nomogram in
patients with triple-negative breast cancer. (A) DCA for 1-year OS
in the training cohort. (B) DCA for 3-year OS in the training
cohort. (C) DCA for 5-year OS in the training cohort. (D) DCA for
1-year OS in the validation cohort. (E) DCA for 3-year OS in the
validation cohort. (F) DCA for 5-year OS in the validation cohort.
Blue curves represent the nomogram incorporating LANI, T stage and
histologic grade, compared with the treat-all (red) and treat-none
(green) strategies. Across clinically relevant thresholds, the
nomogram consistently yielded greater net benefit, underscoring its
potential clinical applicability in risk stratification. DCA,
decision curve analysis; LANI, lymphocyte-albumin-monocyte index; T
stage, tumor stage; OS, overall survival.
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Copy and paste a formatted citation
Spandidos Publications style
Zhang B, Wang K, Aishanjiang M, Lan F and Ma B: <p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>. Oncol Lett 31: 125, 2026.
APA
Zhang, B., Wang, K., Aishanjiang, M., Lan, F., & Ma, B. (2026). <p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>. Oncology Letters, 31, 125. https://doi.org/10.3892/ol.2026.15478
MLA
Zhang, B., Wang, K., Aishanjiang, M., Lan, F., Ma, B."<p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>". Oncology Letters 31.4 (2026): 125.
Chicago
Zhang, B., Wang, K., Aishanjiang, M., Lan, F., Ma, B."<p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>". Oncology Letters 31, no. 4 (2026): 125. https://doi.org/10.3892/ol.2026.15478
Copy and paste a formatted citation
x
Spandidos Publications style
Zhang B, Wang K, Aishanjiang M, Lan F and Ma B: <p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>. Oncol Lett 31: 125, 2026.
APA
Zhang, B., Wang, K., Aishanjiang, M., Lan, F., & Ma, B. (2026). <p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>. Oncology Letters, 31, 125. https://doi.org/10.3892/ol.2026.15478
MLA
Zhang, B., Wang, K., Aishanjiang, M., Lan, F., Ma, B."<p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>". Oncology Letters 31.4 (2026): 125.
Chicago
Zhang, B., Wang, K., Aishanjiang, M., Lan, F., Ma, B."<p>Preoperative lymphocyte‑albumin‑monocyte index as an inflammation‑ and nutrition‑based predictor of overall survival in triple‑negative breast cancer: A retrospective cohort study</p>". Oncology Letters 31, no. 4 (2026): 125. https://doi.org/10.3892/ol.2026.15478
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