Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis. (18th November 2019)

• Record Type: Journal Article
• Authors: Zhou, Jian; Lin, Zhangyu; Lyu, Mengyuan; Chen, Nan; Liao, Hu; Wang, Zihuai; Hao, Jianqi; Yan, Chunyi; Liu, Lunxu
• Is Part Of: Japanese journal of clinical oncology. Volume 50:Number 1(2020)
• Page Start: 44
• Page End: 57
• Publication Date: 2019-11-18
• Subjects: non-small-cell lung cancer -- lymph node excision -- pulmonary surgery -- prognosis -- meta-analysis; Oncology -- Periodicals; Cancer -- Periodicals; 616.994005
• DOI: 10.1093/jjco/hyz120
• Languages: English
• ISSNs: 0368-2811

Abstract

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 < 0.001), disease-free survival (HR: 2.058; 95% CI: 1.717–2.467; P < 0.001) and cancer-specific survival (HR: 2.149; 95% CI: 1.864–2.477; P < 0.001). Subgroup analysis prompted types of lymphadenectomy and the station of positive lymph node have an important effect on the prognosis. No significant discovery was found in sensitivity analysis. Conclusion: Patients with lower lymph node ratio was associated with better survival, indicating that lymph node ratio may be a promising prognostic predictor in non-small-cell lung cancer. The type of lymphadenectomy, an adequate examined number and the removed stations should be considered for more accurate prognosis assessment. Abstract : Lymph node ratio may predict the prognosis of non-small-cell lung cancer patients. Lymphadenectomy types, total examined number and removed stations should also be considered for prognosis evaluation.