Prognostic value of lymph node involvement in oral squamous cell carcinoma

Abstract

Objectives Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. Material and methods This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010–2020. Patients’ records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). Results In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. Conclusions As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. Clinical Relevance MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes.

Lymph node ratio is a superior predictor in surgically treated early-onset pancreatic cancer

“…Dai et al confirmed similarly that a higher LNR was an independent prognostic factor of CSS based on their retrospective study of 1,386 pancreatic cancer (<45 years) (6). LNR has been also regarded as an independent prognostic factor that is strongly associated with the prognosis of various malignancies such as oral cancer, esophageal cancer, breast cancer and medullary thyroid cancer, etc (45)(46)(47)(48). In studies of esophageal cancer and medullary thyroid cancer, LNR showed superior prognostic performance than N stage (46,48).…”

“…Of the entire cohort (n =1048), 548 (52.3%) were men and 799 (76.2%) were white. A total of 1024 (97.7%) patients were aged > 23 years at the time of diagnosis, and the median age at diagnosis was 46 years (IQR, [42][43][44][45][46][47][48]. A total of 712 (67.9%) patients had AJCC TNM stage I-II, and 67 (6.4%) patients had metastasis.…”

Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy

“…However, it remains unclear if there is a sex-dependent response difference regarding AT. The prognostic relevance of LNY and LNR has previously been addressed by several studies, 27,28 and the current American Society of Clinical Oncology guidelines state an LNY threshold of 18 as a parameter for an adequate neck dissection. 29 We showed that in the current study's cohort, low LNY was significantly associated with disease recurrence and mortality for patients without AT, while the optimal cutoff was 20 in both cases, independent of the extent of neck dissection, while a higher LNR was significantly associated with mortality, with a cutoff of 4.6% being identified in this study.…”

Head and neck lymphadenopathy in oral cancer

“…Because the total number of removed LN varies depending on the method of neck dissection, it is important to take this into account when calculating the Lymph Node Ratio (LNR) and Lymph Node Yield (LNY) in the clinical environment [37].…”