Prognostic value of lymph node density in buccal squamous cell carcinoma

Chow, Tam‐Lin; Kwan, Wilson W.Y.; Fung, Siu‐Chung; Ho, Lai-In

doi:10.1016/j.amjoto.2017.05.001

Cited by 17 publications

(18 citation statements)

References 17 publications

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“…The LNR is independently prognostic of overall survival (OS), disease‐specific survival, disease‐free survival (DFS), and locoregional OSCC control. The LNR stratifies patients with the same N classification but different prognoses because of different numbers of LN metastases 11–14 . However, few comparisons between prognostic value of LNR and N were made using the TNM 8th edition 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

et al. 2021

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Background Lymph node metastasis in oral squamous cell carcinoma (OSCC) is associated with poor prognosis. The 8th edition of TNM has implemented new nodal staging criteria. We assess the prognostic utility of the lymph node ratio (LNR) and compare it to that of pN in the TNM 8th edition. Methods One hundred and forty‐two patients with OSCC were retrospectively studied. Nodal staging was performed using the TMN 8th edition and the prognostic value of the LNR in terms of overall survival (OS) and disease‐free survival (DFS) was evaluated. Results Fifty‐seven patients were eligible for inclusion. The LNR was independently prognostic of OS (p = 0.02). Instead N classification was not significantly predictive of OS (p = 0.10). High LNRs resulted in decreases in OS of approximately 40% within 6 months after surgery. Conclusions The LNR identifies patients with poor outcomes better than N classification. The lack of reliable LNR cutoffs compromises its utility in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

et al. 2021

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“…Despite this, given that the technical performance on identifying metastasis of lymph nodes may vary among surgeons 19,20 and pathologists, 21,22 LNR has emerged as a superior prognostic factor for OSCC as well as other solid tumors. [5][6][7][8][9]23 Three factors of LNR have been taken into account in the conventional pN stage, including (a) the true number of positive lymph nodes, (b) the actual number of lymph nodes excised, and (c) the completeness of the pathological analysis. 4 In the present study, our analysis demonstrates that LNR is an independent prognostic factor in patients with locally advanced OSCC, which is consistent with the previous studies that LNR is better than the conventional pN stage for prognostic evaluation in OSCC.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Several studies have reported that LNR is a better predictor than the conventional pN stage in OSCC patients, thus indicating that LNR is an independent prognostic factor for OSCC patients. [4][5][6][7][8][9] We previously conducted a phase 3 trial involving docetaxel, cisplatin, and 5-FU (TPF) induction chemotherapy in patients with locally advanced and resectable OSCC (registration ID, NCT01542931). 10 Neither short-nor long-term follow-up results from the initial trial revealed a significant survival benefit of TPF induction chemotherapy with respect to clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

High‐risk lymph node ratio predicts worse prognosis in patients with locally advanced oral cancer

Zhao

Liang

et al. 2020

J Oral Pathology Medicine

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Background To investigate the prognostic value of lymph node ratio (LNR), as well as the correlation with docetaxel, cisplatin, and 5‐FU (TPF) induction chemotherapy, in patients with locally advanced oral squamous cell carcinoma (OSCC). Methods Two‐hundred and forty‐five patients from a phase 3 trial involving TPF induction chemotherapy in stage III/IVA OSCC patients (NCT01542931) were enrolled in this study between 2008 and 2010. The clinical and pathological data were collected and analyzed. The cutoff value for LNR was calculated on the receiver operating characteristic (ROC) curve. Univariate and multivariate Cox regression models, and Kaplan‐Meier method were used for survival analysis. Results According to the ROC curve, the cutoff value for LNR was 7.6%. With a median follow‐up period of 80 months, the OSCC patients with high‐risk LNR (> 7.6%), or positive extranodal extension (ENE) had significantly worse clinical outcomes than patients with low‐risk LNR (≤7.6%) or negative ENE. Multivariate analysis on pathological covariates showed that only high‐risk LNR was an independent negative predictive factor for survival (P < .05). The cutoff value of LNR of 7.6% was also verified with the similar results using an open TCGA database, high‐risk LNR indicating worse overall survival (P < .001) and disease‐free survival (P < .001). Conclusion Oral squamous cell carcinoma patients with high‐risk LNR have a worse clinical outcome than patients with low‐risk LNR. High‐risk LNR is an independent negative predictive factor for clinical outcome in patients with locally advanced OSCC.

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“…To solve this problem, the number of involved lymph nodes to all dissected lymph nodes, named as LNR or density, has been discussed as a prognostic factor in recent studies. [ 22 23 ] In this provided method, more dissection resulted in more lymph node finding, but because of using the ratio, the operator dependency was excluded. [ 24 25 ] LNR has also been discussed as a prognostic factor in other cancers such as gastric, breast, and colon cancers.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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

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Prognostic value of lymph node density in buccal squamous cell carcinoma

Cited by 17 publications

References 17 publications

Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

Comparing prognostic utility between the 8th edition of TNM staging system and the lymph node ratio for oral squamous cell carcinoma

High‐risk lymph node ratio predicts worse prognosis in patients with locally advanced oral cancer

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

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