Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis

Abstract Background This meta-analysis aimed to investigate the prognostic value of lymph node ratio in non-small-cell lung cancer. Methods We searched systematically for eligible studies in PubMed, Web of Science, Medline (via Ovid) and Cochrane library through 6 November 2018. The primary outcome was overall survival. Disease-free survival and cancer-specific survival were considered as secondary outcomes. Hazard ratio with corresponding 95% confidence interval were pooled. Quality assessment of included studies was conducted. Subgroup analyses were performed based on N descriptors, types of tumor resection, types of lymphadenectomy and study areas. Sensitivity analysis and evaluation of publication bias were also performed. Results Altogether, 20 cohorts enrolling 76 929 patients were included. Mean Newcastle–Ottawa Scale was 7.65 ± 0.59, indicating the studies’ quality was high. The overall result showed non-small-cell lung cancer patients with lower lymph node ratio was associated with better overall survival (HR: 1.946; 95% CI: 1.746–2.169; P