Lymph node ratio as a prognostic factor in head and neck cancer patients.

Chien-Chih Chen,Jin-Ching Lin,Kuan-Wen Chen

doi:10.1186/s13014-015-0490-9

Abstract

BackgroundLymph node status is one prognostic factor in head and neck cancer. The purpose of this study is to investigate the prognostic value of lymph node ratio (LNR) in head and neck cancer patients who received surgery plus postoperative chemoradiotherapy.MethodsFrom May 1991 to December 2012, a total of 117 head and neck cancer patients who received surgery plus postoperative chemoradiotherapy were analyzed. The primary sites were oral cavity (93), oropharynx (13), hypopharynx (6), and larynx (5). All patients had pathologically confirmed squamous cell carcinoma and 63 patients had neck lymph nodes metastasis. LNR was calculated for each patient. The endpoints were overall survival (OS), local failure-free survival (LFFS), and distant metastasis-free survival (DMFS).ResultsThe median follow up time was 36 months, with a range from 3.4 to 222 months. The 3-year rates of OS, LFFS, and DMFS were 59.7, 70.3, and 81.8 %, respectively. The median value of LNR for lymph nodes positive patients was 0.1. In univariate analysis, patients with an LNR value less than 0.1 had better 3-year OS (67.0 % vs.41.0 %, p = 0.004), 3-year LFFS (76.1 % vs. 54.9 %, p = 0.015) and 3-year DMFS (87.2 % vs. 66.4 %, p = 0.06).Multivariate analysis revealed that LNR was an independent prognostic factor for OS (hazard ratio [HR] = 2.92; 95 % confidence interval [CI] = 1.367–6.242; p = 0.006) and LFFS (HR = 4.12; 95 % CI = 1.604–10.59; p = 0.003).ConclusionLNR is an important prognosis factor for OS and LFFS in head and neck cancer patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-015-0490-9) contains supplementary material, which is available to authorized users.

Highlights

Lymph node status is one prognostic factor in head and neck cancer
Pathologic lymph node status was evaluated by 2 pathologists and lymph node ratio (LNR) was calculated for each patient
Histopathologic examination revealed that 35 patients had positive margin, 63 patients had lymph nodes metastasis, and 25 patients had extracapsular extension

Summary

Introduction

Lymph node status is one prognostic factor in head and neck cancer. The purpose of this study is to investigate the prognostic value of lymph node ratio (LNR) in head and neck cancer patients who received surgery plus postoperative chemoradiotherapy. Squamous cell carcinoma (SCC) of head and neck is one of the common malignant tumors worldwide. Even after patients receive surgery plus adjuvant therapy for head and neck cancer, some of them may still experience relapse. It is important to improve treatment outcome by finding reliable prognostic factors and identifying head and neck cancer patients at high risk of relapse. One of the most commonly used prognostic factors is the tumor-node-metastasis (TNM) staging system. The TNM staging system classifies lymph nodes status by the number, size, and laterality of positive lymph nodes [4].

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