SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Prognostic Value of Lymph Node Ratio After Neoadjuvant Chemotherapy for Gastric Cancer: A Systematic Review and Meta-analysis
Provisionally accepted
- 1First People's Hospital of Jingzhou, Jingzhou, China
- 2The University of Newcastle College of Health Medicine and Wellbeing, Callaghan, Australia
- 3Chengdu Medical College Chengdu Seventh People's Hospital, Chengdu, China
- 4Chengdu Medical College, Chengdu, China
- 5Dazhou Vocational College of Traditional Chinese Medicine, Dazhou, China
- 6The First People's Hospital of Jingzhou, Jingzhou, China
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Background: The prognostic value of the lymph node ratio (LNR) in gastric cancer treated with neoadjuvant chemotherapy (NACT) remains unclear, as conventional pathological nodal assessment after neoadjuvant therapy may be affected by treatment-induced changes. This meta-analysis evaluated whether LNR retains prognostic significance in patients undergoing neoadjuvant chemotherapy followed by curative gastrectomy. Methods: PubMed, MEDLINE, CENTRAL, Web of Science, Embase, and ClinicalTrials.gov were searched from inception to October 20, 2025. Retrospective cohort studies reporting hazard ratios (HRs) for survival outcomes based on LNR after NACT were included. Overall survival was the primary outcome; disease-free survival was a secondary outcome. Prespecified subgroup analyses were performed by LNR cutoff (≥0.30 vs <0.30) and neoadjuvant regimen (chemotherapy vs chemo–immunotherapy). Results: Seven studies involving 2,437 patients met inclusion criteria.Six studies reported overall survival,one study reported disease-specific survival. High LNR was strongly associated with poorer overall survival (OS)(HR = 3.48, 95% CI: 2.27–5.33) and inferior disease-free survival(DFS) (HR = 1.94, 95% CI: 1.24– 3.06). Subgroup analysis showed a significant interaction by LNR cutoff (p = 0.03), but no interaction by neoadjuvant treatment modality (p = 0.49). Sensitivity analyses confirmed the stability of results. Conclusions:
Keywords: gastric cancer, lymph node ratio, Meta-analysis, Neoadjuvant chemotherapy, Overall survival (OS)
Received: 27 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Liu, Da, Shu, Huang, Zhang, Wei, Yang and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiang Da
Kun Du
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