Prognostic value of lymph node ratio in patients with pathological N1 non-small cell lung cancer: A systematic review with metaanalysis

Qian Li, Ping Zhan, Dongmei Yuan, Tangfeng Lv, Alexander Sasha Krupnick, Antonio Passaro, Alessandro Brunelli, Matthew P. Smeltzer, Raymond U. Osarogiagbon, Yong Song

Research output: Contribution to journalArticle


Background: Non-small cell lung cancer (NSCLC) patients with N1 disease have variable outcomes, and additional prognostic factors are needed. The number of positive lymph nodes (LNs) has been proposed as a prognostic indicator. However, the number of positive LNs depends on the number of LNs examined from the resection specimen. The lymph node ratio (LNR) can circumvent this limitation. The purpose of this study is to evaluate LNR as a predictor of survival and recurrence in patients with pathologic N1 NSCLC. Methods: We systematically reviewed studies published before March 17, 2016, on the prognostic value of LNR in patients with pathologic N1 NSCLC. The hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to combine the data. We also evaluated heterogeneity and publication bias. Results: Five studies published between 2010 and 2014 were eligible for this systematic review with metaanalysis. The total number of patients included was 6,130 ranging from 75 to 4,004 patients per study. The combined HR for all eligible studies evaluating the overall survival (OS) and disease-free survival (DFS) of N1 LNR in patients with pathologic N1 NSCLC was 1.53 (95% CI: 1.22-1.85) and 1.64 (95% CI: 1.19-2.09), respectively. We found no heterogeneity and publication bias between the reports. Conclusions: LNR is a worthy predictor of survival and cancer recurrence in patients with pathological N1 NSCLC.

Original languageEnglish
Pages (from-to)258-264
Number of pages7
JournalTranslational Lung Cancer Research
Issue number3
Publication statusPublished - Jun 1 2016



  • Lymph node ratio (LNR)
  • Meta-analysis
  • N1 node
  • Non-small cell lung cancer (NSCLC)

ASJC Scopus subject areas

  • Oncology

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