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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 &amp;lt; 0.001), disease-free survival (HR: 2.058; 95% CI: 1.717–2.467; P &amp;lt; 0.001) and cancer-specific survival (HR: 2.149; 95% CI: 1.864–2.477; P &amp;lt; 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.

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