Lymph node ratio as a prognostic marker in advanced laryngeal and hypopharyngeal carcinoma after primary total laryngopharyngectomy

Abstract

Laryngopharyngectomy followed by adjuvant radiotherapy (PORT) or primary radiochemotherapy represents the treatment of choice for locally advanced laryngeal and hypopharyngeal carcinoma. 1 Despite increasing insights into the molecular pathways and constant efforts to improve therapy regimens, the outcome of patients with advanced stage disease remains poor. 2,3 Particularly, 50%-70% of patients with stage III or IV disease will die due to disease 5 years after the diagnosis. 4 Locoregional and distant failure are the major prognostic determinants, and therefore, the primary factor of mortality in this patient population with recurrence rates ranging between 25% and 50%. 5 Regional lymph node metastases, advanced stage disease, surgical resection margin and extracapsular extension are established risk factors for locoregional recurrence or distant metastasis in laryngeal and hypopharyngeal carcinoma. [6][7][8] Nevertheless, identification of new prognostic factors for recurrence is of utmost importance as it may improve treatment strategies and post-therapeutic surveillance.Recently, the lymph node ratio (LNR) has been shown to be an important prognostic factor in bladder, oesophageal and oral squamous cell carcinomas (SCCs). 9-11 LNR is defined as the ratio of positive lymph nodes to the total number of dissected lymph nodes. Although studies have also been performed in patients with laryngeal and hypopharyngeal cancer, the prognostic value of LNR was contradictory because the prognostic power of LNR was not significant for all

Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: a systematic review and meta-analysis

“…Quality scores of 8 studies [14,16,[18][19][20][21][22]27] were more than 5, indicating that most of the studies were moderate quality. [12,15,18,29] explored the association between LNR and OS, DSS, DFS outcomes respectively. The pooled analysis of studies reported LNR as the categorical variable showed the higher LNR values were associated with short OS (HR 1.85, 95%CI 1.47 to 2.32, 9 studies) in the random-effect model (I 2 = 58.4%) ( Fig.…”

“…Since metastatic lymph node burden is one of the most important prognostic indicators of head and neck cancers [4,[32][33][34], and can increase the recurrence rate and mortality [33,35], a variety of features of lymph nodes as prognostic indicators for head and neck cancer, were investigated thoroughly. As for LHSCC, extracapsular spread (ECS) [35], number of positive lymph nodes [12,13,32], and lymph node yield [18,36,37] were reported. In recent years, several studies suggested that LNR or LND was an independent risk factor for patients with head and neck cancers [4,33,[37][38][39], including LHSCC [13-16, 18, 19, 21, 22], while some other studies found no significant relationship between survival and the LNR or LND for LHSCC [12,40].…”

“…DFS: Disease-free survival; HR: Hazard ratio; LHSCC: Laryngeal and hypopharyngeal squamous cell carcinoma Fourthly, we grouped all LHSCC to review, which may bias the accuracy of the results. But two studies [12,18] exploring the prognostic value of LNR in LHSCC demonstrated that tumor site, whether laryngeal or hypopharyngeal, had no significant on OS, DSS and DFS. Besides, we analyzed the LSCC data separately from the HPSCC, and the subgroup analysis results was similar with the overall.…”

“…We had access to all published articles which evaluated the prognostic values of LNR in LHSCC, and included articles that were published in English, studied LHSCC patients with positive lymph nodes, reported calculated LND or LNR, clarified the LNR-related outcomes, and applied multivariate regression analysis to analyze the relationship between LNR and outcomes. As previous studies showed that no significant difference was noted between LSCC and HPSCC in LNR [18], we combined LSCC with LSCC for analysis.…”

Long-term survival trend after primary total laryngectomy for patients with locally advanced laryngeal carcinoma

“…The cumulation of tobacco could hardly be eliminated even after primary TL. It was recognized by several studies that the tumor invasive ability manifests largely in the form of lymph node ratio [11,23,24]. Patients with a higher LNR had inferior long-term survival than those with low LNR.…”