Lymph node ratio as a predictor for outcome in oral squamous cell carcinoma: a multicenter population-based cohort study

Steffen Spoerl,Gerrit Spanier,Michael Gerken,Johannes K Meier,Silvia Spoerl,René Fischer,Stefanie Wolf,Andreas Mamilos,Christoph Klingelhöffer,Tobias Ettl,Torsten E Reichert,Felix Nieberle

doi:10.1007/s00784-020-03471-6

Abstract

ObjectivesRecently, multiple studies addressed the importance of lymph node ratio (LNR) in specifying patients’ risk of disease recurrence in various malignancies. The present study examines the prognostic significance of LNR in predicting outcome of oral squamous cell carcinoma (OSCC) patients after surgical treatment with curative intent.MethodsHere, we describe a retrospective population-based cohort with 717 patients previously diagnosed with OSCC. Histopathologically verified lymph node metastasis was diagnosed in 290 patients. Among these patients, we evaluated the impact of LNR on overall survival (OAS) and recurrence-free survival (RFS) in uni- as well as multivariate analysis.ResultsA median cutoff (0.055) in LNR was found to significantly predict outcome in OSCC patients. Five-year OAS was 54.1% in patients with a low LNR, whereas a high LNR was associated with a 5-year OAS of 33.3% (p < 0.001). Similar results were detected for RFS with a 5-year survival rate of 49.8% (LNR low) and 30.3% (LNR high) (p = 0.002). Results were confirmed in multivariate Cox regression which substantiated the importance of LNR in predicting survival in OSCC patients.ConclusionsLNR was shown to be an independent prognostic factor for outcome of OSCC in a population-based cohort in uni- as well as multivariate analysis. Hereby, a LNR ≥ 0.055 predicted a shorter OAS and RFS in our cohort.Clinical relevanceBesides established histopathological factors, LNR can be used as a reliable predictor of outcome in OSCC and might therefore be further applied in evaluating adjuvant treatment after resection in curative intention.

Highlights

In 290 patients (40.4%), lymph node metastasis was diagnosed after tumor resection, and most tumors were staged UICC class IV (37.1%)
In patients with histopathological verification of lymph node metastasis (n = 290), neck dissection resulted in a median lymph node yield of 38.0
Differences in clinicopathological characteristics in patients with positive lymph nodes according to bivariate lymph node ratio (LNR) distribution were evaluated: Here, significant differences were seen for adjusted Charlson comorbidity index (ACCI) (p = 0.048), extent of neck dissection (p = 0.002), pT- and pNstage (p = 0.004, p < 0.001), UICC stage (p < 0.001) as well as histopathological verification of extranodal spread (p < 0.001) (Table 3)

Summary

Introduction

Tumor Center—Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany. Oral squamous cell carcinoma (OSCC) is one of the most common tumor entities worldwide. Apart from the HPV status, biomarkers to predict the outcome of OSCC patients, in advanced stage disease, are still of utmost importance [3, 4]. In patients with advanced disease, adjuvant treatment remains essential [5], including novel therapeutic approaches in metastatic and recurrent disease: Immunotherapy thereby provides promising treatment options for OSCC patients and consecutively got implemented in routine patient care over the last years [6]. The KEYNOTE048 phase 3 study focused on Pembrolizumab in HNSCC patients with metastatic or recurrent disease.

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