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Background Lymph node ratio (LNR) has recently been reported as a potential prognostic marker in many malignant diseases.We aimed to analyze the potential prognostic effect of LNR on hypopharyngeal squamous cell carcinoma (HPSCC) after neoadjuvant therapy in our institution.Methods We performed a retrospective study of 279 patients with HPSCC who underwent radiotherapy with or without chemotherapy followed by neck dissection between November 1965 and December 2008.Patients were divided into four groups according to quartiles based on LNR.Results The mean LNR was 10.4％ (range 0-100％,median 4.3％).Males and advanced clinical N classification significantly increased the LNR (P=0.014 and P ＜0.001,respectively).Compared with those with LNR ＜0.14,LNR ＞0.14 was associated with reduced overall,disease-specific and disease-free survival (all at P ＜0.001).Multivariate analysis revealed that LNR is an independent predictor of prognosis.Conclusion Our results suggest that LNR is a strong predictor of HPSCC after chemoradiotherapy.