A critical evaluation of lymph node ratio in head and neck cancer

M. de Ridder*, C. C.M. Marres, L. E. Smeele, M. W.M. van den Brekel, M. Hauptmann, A. J.M. Balm, M. L.F. van Velthuysen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)

Abstract

In head and neck squamous cell carcinoma (HNSCC), the search for better prognostic factors beyond TNM-stage is ongoing. Lymph node ratio (LNR) (positive lymph nodes/total lymph nodes) is gaining interest in view of its potential prognostic significance. All HNSCC patients at the Netherlands Cancer Institute undergoing neck dissection for lymph node metastases in the neck region between 2002 and 2012 (n = 176) were included. Based on a protocol change in specimen processing, the cohort was subdivided in two distinct consecutive periods (pre and post 2007). The prognostic value of LNR, N-stage, and number of positive lymph nodes for overall survival was assessed. The mean number of examined lymph nodes after 2007 was significantly higher (42.3) than before (35.8) (p = 0.024). The higher number concerned mostly lymph nodes in level V. The mean number of positive lymph nodes before 2007 was 3.3 vs. 3.6 after 2007 (p = 0.745). By multivariate analysis of both pre- and post-2007 cohort data, two factors remained associated with an increased hazard of dying: N2 [HR 2.1 (1.1–4.1) and 2.4 (1.0–5.8)] and >3 positive lymph nodes [HR 2.0 (1.1–3.5) and 3.1 (1.4–6.9)]. Hazard ratio for LNR >7 % was not significantly different: pre 2007 at 2.2 (1.3–3.8) and post 2007 at 2.1 (1.0–4.8, p = 0.053). In this study, changes in specimen processing influenced LNR values, but not the total number of tumor positive nodes found. Therefore, in HNSCC, the number of positive nodes seems a more reliable parameter than LNR, provided a minimum number of lymph nodes are examined.

Original languageEnglish
Pages (from-to)635-641
Number of pages7
JournalVirchows Archiv
Volume469
Issue number6
DOIs
Publication statusPublished - 1 Dec 2016
Externally publishedYes

Keywords

  • Head and neck cancer
  • Lymph node metastases
  • Lymph node ratio
  • Prognosis
  • Staging

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