The prognostic value of lymph node ratio in survival ofhead-and-neck squamous cell carcinoma

Introduction: Head-and-neck squamous cell carcinoma (HNSCC) is the sixth most prevalent typeof cancers in the world. Due to its relatively high rate of recurrence, the prognosis of patients ispoor and the survival rate is low; therefore, identifying the prognosticfactors is considerednecessary for better treatment.Materials and Methods: This historical cohort study was conducted on 201 patients diagnosedwith aerodigestive SCC who underwent surgery and lymph node dissection. We determined theprognostic 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 survivalby 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 wereevaluated. The 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, andLFFS were 32%, 21%, and 64%, respectively. The median of OS was 40.70 months and 30.11months in patients with LNR of ≤0.06 and 0.06, respectively (P 0.01). The LNR 0.06 wasfound to be significant prognostic factor for lower OS of patients with HNSCC (HR 2.11 [1.10 4.40]; 0.04). DFS was not significantly different among patients with LNR ≤0.06 and patientswith LNR 0.06 (P 0.9). However, LFFS was slightly different among two groups (HR 2.04[0.90–4.80]; 0.1).Conclusion: We recommend more intensive adjuvant therapies such as chemotherapy withradiotherapy and short interval follow-up for patients with LNR 0.06. Further investigations withlarger sample sizes are recommended