Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Jpn J Clin Oncol. 2020 Jan 24;50(1):44-57. doi: 10.1093/jjco/hyz120.
This meta-analysis aimed to investigate the prognostic value of lymph node ratio in non-small-cell lung cancer.
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.
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.
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.
本荟萃分析旨在研究淋巴结比率在非小细胞肺癌中的预后价值。
我们通过 2018 年 11 月 6 日检索 PubMed、Web of Science、Medline（通过 Ovid）和 Cochrane 图书馆，系统地搜索了合格的研究。主要结局是总生存率。无病生存率和癌症特异性生存率被视为次要结局。采用相应的 95%置信区间的风险比进行合并。对纳入研究进行质量评估。根据 N 描述符、肿瘤切除术类型、淋巴结切除术类型和研究区域进行亚组分析。还进行了敏感性分析和发表偏倚评估。
总共纳入了 20 个队列，共纳入了 76929 名患者。平均 Newcastle-Ottawa 量表评分为 7.65±0.59，表明研究质量较高。总体结果显示，非小细胞肺癌患者淋巴结比率较低与更好的总生存率（HR：1.946；95%CI：1.746-2.169；P<0.001）、无病生存率（HR：2.058；95%CI：1.717-2.467；P<0.001）和癌症特异性生存率（HR：2.149；95%CI：1.864-2.477；P<0.001）相关。亚组分析提示淋巴结切除术类型和阳性淋巴结站对预后有重要影响。敏感性分析未发现显著发现。
淋巴结比率较低的患者生存率较好，表明淋巴结比率可能是非小细胞肺癌有前途的预后预测指标。为了更准确地评估预后，应考虑淋巴结切除术类型、充分检查的淋巴结数量和切除的淋巴结站。
