Re-evaluating Lymph Node Yield, Lymph Node Ratio, and the number of metastatic nodes as prognostic factors in oral cavity squamous cell carcinoma

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2025-05-22 DOI:10.1016/j.oraloncology.2025.107391

Dean Dudkiewicz , Nir Tsur , Dan Yaniv , Esmat Najjar , Thomas Shpitzer , Aviram Mizrachi , Moshe Yehuda , Gideon Bachar , Eyal Yosefof

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引用次数: 0

Abstract

Objective

Previous studies of Lymph Node Yield (LNY) for neck dissection in Oral Cavity Squamous Cell Carcinoma (OCSCC) have shown LNY of 18 or more lymph nodes to be of prognostic value. This study aims to evaluate the prognostic implications of LNY, number of metastatic nodes, and Lymph Node Ratio (LNR) in clinical N0 OCSCC.

Methods

We retrospectively analyzed 118 patients who underwent elective neck dissection for OCSCC at Rabin Medical Center (2000–2020). Demographic, clinical, pathological, and surgical data were collected. We examined the prognostic significance of LNY cutoffs (18 and 13), number of positive nodes, and LNR on disease-free and overall survival.

Results

The mean LNY was 19.5 ± 11.3 nodes, with a lymph node metastasis rate of 31.3 %. Statistical analysis showed that neither 18 nor 13 lymph nodes had significant prognostic value for recurrence or survival. The mean LNR was 4.52 % ± 11.3 %, with higher LNR values (>3.4 %) significantly associated with increased recurrence (p = 0.003) and reduced survival intervals (p = 0.003). Cox regression analysis further confirmed that both elevated LNR and the presence of more than two metastatic lymph nodes were independently associated with increased mortality.

Conclusions

Our findings challenge the commonly cited LNY threshold of 18, as no specific LNY cutoff conferred significant survival benefits. Instead, LNR emerged as a superior prognostic marker, correlating strongly with overall survival and locoregional control. Incorporating LNR into prognostic models may enhance risk stratification and guide clinical decision-making in OCSCC management.

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重新评估口腔鳞状细胞癌的淋巴结产量、淋巴结比例和转移淋巴结数量作为预后因素

目的以往对口腔鳞状细胞癌（OCSCC）颈部清扫的淋巴结量（LNY）的研究表明，18个及以上淋巴结的淋巴结量（LNY）具有预后价值。本研究旨在评估LNY、转移淋巴结数量和淋巴结比（LNR）在临床N0 OCSCC中的预后意义。方法回顾性分析Rabin医疗中心（2000-2020）118例择期颈部清扫术治疗OCSCC的患者。收集了人口学、临床、病理和手术资料。我们检查了LNY截止点（18和13）、阳性淋巴结数量和LNR对无病生存和总生存的预后意义。结果LNY平均为19.5±11.3个淋巴结，淋巴结转移率为31.3%。统计分析显示18和13个淋巴结对复发或生存均无显著预后价值。平均LNR为4.52%±11.3%，较高的LNR值（> 3.4%）与复发率增加（p = 0.003）和生存期缩短（p = 0.003）显著相关。Cox回归分析进一步证实，LNR升高和两个以上转移性淋巴结的存在与死亡率增加独立相关。我们的研究结果挑战了通常引用的LNY阈值18，因为没有特定的LNY临界值能带来显著的生存益处。相反，LNR作为一种优越的预后指标，与总生存率和局部控制密切相关。将LNR纳入预后模型可以加强风险分层，指导临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.