The prognostic value of lymph node ratio in survival of head?and?neck squamous cell carcinoma

Reza Eshraghi Samani, Mohammad Shirkhoda, Maryam Hadji, Faramarz Beheshtifard, Seyed Mohammad Mehdi Ghaffari Hamedani, Ali Momen, Mahtab Mollashahi, Kazem Zendehdel


Background: Head?and?neck squamous cell carcinoma (HNSCC) is the sixth most prevalent type of cancers in the world. Due to its relatively high rate of recurrence, the prognosis of patients is poor and the survival rate is low; therefore, identifying the prognostic factors is considered necessary for better treatment. Materials and Methods: Tis historical cohort study was conducted on 201 patients diagnosed with aerodigestive SCC who underwent surgery and lymph node dissection. We determined the prognostic value of lymph node ratio (LNR) on overall survival (OS), disease?free survival (DFS), and locoregional failure?free survival (LFFS).
We noticed an association between LNR and survival by Kaplan–Meier analysis. Hazard ratio (HR) of LNR was determined by Cox’s regression model. Results: Two hundred and one patients entered this study after their medical histories were evaluated. Te mean of lymph node count and LNR was 14.30 (±9.50) and 0.12 (±0.23), respectively. Eighty patients (39.80%) experienced recurrence of SCC. Five?year OS, DFS, and LFFS were 32%, 21%, and 64%, respectively. Te median of OS was 40.70 months and 30.11 months in patients with LNR of ?0.06 and >0.06, respectively (P < 0.01). Te LNR >0.06 was found to be a signifcant prognostic factor for lower OS of patients with HNSCC (HR = 2.11 [1.10, 4.40]; P = 0.04). DFS was not signifcantly di?erent among patients with LNR ?0.06 and patients with LNR >0.06 (P = 0.9). However, LFFS was slightly di?erent among two groups (HR = 2.04 [0.90–4.80]; P < 0.1). Conclusion: We recommend more intensive adjuvant therapies such as chemotherapy with radiotherapy and short interval follow?up for patients with LNR >0.06. Further investigations with larger sample sizes are recommended.


Head?and?neck squamous cell carcinoma, lymph node ratio, survival

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