**5. Conclusions**

Our preliminary results indicate that total TLG was a more significant independent prognostic factor than TLG when calculated from either primary tumor or metastatic nodes in predicting survival outcomes in patients with M0 NSCLC. Total TLG and age were predictive biomarkers for both OS and PFS, while ECOG status was an independent prognostic factor for OS. Combining total TLG with clinical factors yielded a survival stratification model that performed better than the traditional AJCC staging system. Our proposed survival stratification model may allow a more precise therapeutic approach in patients with nodal metastatic NSCLC without distant metastasis.

**Supplementary Materials:** The following are available online at https://www.mdpi.com/2075-441 8/11/6/1065/s1: Table S1: Results of receiver operating characteristic curve analysis. Figure S1. In the OS model, the combination of three independent risk factors resulted in eight different patient hazards (from 1 to 43.8). The combination of two independent risk factors of the PFS model resulted in four different patient hazards (from 1 to 8.9). We further re-stratified patients with similar 5-year survival outcomes in the Kaplan–Meier curve analysis into one risk category. Finally, we obtained three separate risk categories in our survival models. OS, overall survival; PFS, progression-free survival. Table S2: The results of the bootstrapping validation of our survival analysis. Table S3: The mean age according to the histopathology and treatment strategy.

**Author Contributions:** Y.-H.C. and S.-C.C. (Sheng-Chieh Chan) have full access to all the study data; study design, Y.-H.C., S.-C.C. (Sung-Chao Chu), S.-C.C. (Sheng-Chieh Chan), and T.-F.W.; image analysis, Y.-H.C., S.-C.C. (Sheng-Chieh Chan), and S.-H.L.; image feature extraction, Y.-H.C. and K.-H.L.; statistical analysis and data curation, Y.-H.C. and L.-Y.W.; article drafting, Y.-H.C., L.-Y.W., and S.-C.C. (Sheng-Chieh Chan); critical revision of the article's important intellectual content, Y.-H.C., S.-C.C. (Sung-Chao Chu), T.-F.W., L.-Y.W., C.-B.L., B.-S.C., D.-W.L., K.-H.L., and S.-C.C. (Sheng-Chieh Chan). All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by The Ministry of Science and Technology in Taiwan, gran<sup>t</sup> number 109-2314-B-303-015.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board and Ethics Committee of Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (protocol code IRB109-235-B; date of approval: 22 September 2020).

**Informed Consent Statement:** Patient consent was waived due to the retrospective nature of this study.

**Data Availability Statement:** The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical restrictions.

**Acknowledgments:** The authors wish to thank the staff from the Lung Cancer Research Team of Buddhist Tzu Chi General Hospital for their assistance in retrieving the data of patients with NSCLC.

**Conflicts of Interest:** The authors declare no conflict of interest.
