title: Can metastatic lymph node ratio (LNR) predict survival in oral cavity cancer patients?
abstract: OBJECTIVE
  To evaluate the prognostic role of the lymph node ratio (LNR; ratio of total positive nodes to total dissected nodes) in oral squamous cell carcinoma (OSCC) as compared to pN staging with an aim to provide an optimal cut-off value.
  
  
  METHODS
  1,408 OSCC previously untreated patients who underwent treatment (surgery + neck dissection + adjuvant treatment). LNR sensitivity with respect to survival was calculated using receiver operating characteristic (ROC) curves and Cox regression method. LNR and TNM staging variables were subjected to multivariate analysis.
  
  
  RESULTS
  LNR (0.088) showed significant association with survival outcomes. For patients with LNR ≤0.088, the OS, DFS, local control, regional control and distant metastasis rates were 64%, 70%, and 89%; for LNR >0.088 it was 22%, 19%, and 52%, respectively (P < 0.001). On multivariate analysis LNR of 0.088 was seen to be an independent prognostic factor for 5-year regional control (p, hazard ratio [95% confidence interval]; 0.044, 2.016 (1.019-3.990), DFS, 0.032, 1.858 (1.054-3.276), and OS, 0.040, 1.195 (1.033-1.144). On multivariate analysis LNR categorization showed a statistically significant [0.032, 1.858, (1.054-3.276)] advantage over pN staging [0.527, 1.208 (1.054-3.276)] in predicting survival.
  
  
  CONCLUSIONS
  LNR is a better prognostic marker than the current N staging of TNM classification.
authors.affiliation: Head Neck Services, Tata Memorial Hospital, Parel, Mumbai, India.
authors.forename: Suhail I
authors.initials: SI
authors.lastname: Sayed
authors.forename: Shilpi
authors.initials: S
authors.lastname: Sharma
authors.forename: Pawan
authors.initials: P
authors.lastname: Rane
authors.forename: Sagar
authors.initials: S
authors.lastname: Vaishampayan
authors.forename: Sanjay
authors.initials: S
authors.lastname: Talole
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chaturvedi
authors.forename: Devendra
authors.initials: D
authors.lastname: Chaukar
authors.forename: Anuja
authors.initials: A
authors.lastname: Deshmukh
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Agarwal
authors.forename: Anil K
authors.initials: AK
authors.lastname: D'cruz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies
keywords: metastatic lymph node ratio; neck metastasis; oral cavity cancer