Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: A systematic review and meta-analysis

Abstract

Background: Several recent studies have indicated that the lymph node ratio (LNR) is an independent prognostic factor for laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). The purpose of this paper is to assess the prognostic value of LNR and explore appropriate cutoff values by conducting a systematic review and metaanalysis. Methods: Pubmed, Embase (via Ovid), and Cochrane library were systematically searched for studies on the prognostic value of LNR in LHSCC up to October 31, 2019. Then, Literature review, data extraction, and quality assessment of eligible studies were performed by two independent reviewers back-to-back. Lastly, Stata 14.0 software was hired to conduct a meta-analysis. Results: A total of 445 articles were retrieved, and 13 studies published in English between 2013 and 2019 were included after the title/abstract and full-text screening. Among the 13 studies contributed to 4197 patients, seven studies were about hypopharyngeal squamous cell carcinoma (HPSCC), four studies about laryngeal squamous cell carcinoma (LSCC), and the remaining two studies about LHSCC. The meta-analysis results showed that shorter overall survival (OS) (HR 1.49; 95%CI: 1.18 to 1.88), disease-specific survival (DSS) (HR 1.66; 95%CI: 1.32 to 2.07) and disease-free survival (DFS) (HR 2.04; 95%CI: 1.54 to 2.71) were significantly correlated with a higher LNR in a random-effect model. The cutoff values of eligible studies were varied from 0.03 to 0.14, and the lowest significant LNR was 0.044. Conclusion: LNR is a valuable prognostic factor in the survival of LHSCC and may be used to improve the tumor staging systems, which, however, requires the solid support of more high-quality studies.

Long-term survival trend after primary total laryngectomy for patients with locally advanced laryngeal carcinoma

“…The cumulation of tobacco could hardly be eliminated even after primary TL. It was recognized by several studies that the tumor invasive ability manifests largely in the form of lymph node ratio 11 , 23 , 24 . Patients with a higher LNR had inferior long-term survival than those with low LNR.…”

“…Age was classified into two groups (<60 and ≥60). The cut-off point for lymph node ratio (LNR) was previously reported ranging from 0.03 to 0.14 10 , 11 , and in this study, we used using the “X-tile” program (Yale University, USA) to obtain the optimal point 12 . Accordingly, the LNR was divided into three groups (< 0.03, ≥ 0.03, no neck dissection).…”

Magnetic resonance imaging-derived radiomic signature predicts locoregional failure after organ preservation therapy in patients with hypopharyngeal squamous cell carcinoma

“…It would not be surprising that the addition of clinicopathological features such as tumor invasion status or lymph node disseminated the extent and radiographic information from regional lymphadenopathies will improve the current RS model. Previous studies demonstrated that male sex, advanced age, tumor size, tumor invasion, lymph node stage, comorbid conditions, poor performance scores, human papillomavirus infection, and programmed death ligand-1 expression level are poor prognostic factors in patients with HPSCC [45][46][47]. Although radiomic research studies are still emerging, our RS model provided higher sensitivity and specificity than tumor volume in predicting locoregional recurrence in patients with advanced HPSCC, indicating that, in addition to clinicopathological factors, RS is a useful tool for predicting local failure in patients with advanced HPSCC who want to receive OPT.…”

Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

“…[6][7][8] Two more pathological indices related to neck dissection that have also proven their independent prognostic value in head and neck squamous cell carcinoma are lymph node yield and lymph node ratio. [9][10][11][12][13][14][15][16][17][18] While the lymph node yield is the total number of lymph nodes removed in a given neck dissection, the lymph node ratio (also known as lymph node density) represents the ratio of metastatic lymph nodes to the total number of lymph nodes harvested. Though lymph node yield and lymph node ratio are yet to find their places in mainstream clinical guidelines and practice, they are the only available parameters at present for qualifying and quantifying the adequacy of neck dissection.…”

“…From a prognostic point of view, numerous systematic reviews and meta-analyses have highlighted that the survival rates in head and neck squamous cell carcinoma can be improved by increasing the lymph node yield or by decreasing the lymph node ratio. [13][14][15][16][17] As a result, surgeons and pathologists worldwide have been looking for effective ways to increase the lymph node yield and reduce the lymph node ratio. [19][20][21][22][23] Apart from the expertise and dedication of the surgeon and the pathologist, a few other determinants could also affect these outcomes of neck dissection.…”