Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research.
BACKGROUND
Lymph node density (LND) has previously been reported to reliably predict recurrence risk and survival in oral cavity squamous cell carcinoma (OSCC). This multicenter international study was designed to validate the concept of LND in OSCC.


METHODS
The study included 4254 patients diagnosed as having OSCC. The median follow-up was 41 months. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control and distant metastasis rates were calculated using the Kaplan-Meier method. Lymph node density (number of positive lymph nodes/total number of excised lymph nodes) was subjected to multivariate analysis.


RESULTS
The OS was 49% for patients with LND0.07 compared with 35% for patients with LND>0.07 (P<0.001). Similarly, the DSS was 60% for patients with LND0.07 compared with 41% for those with LND>0.07 (P<0.001). Lymph node density reliably stratified patients according to their risk of failure within the individual N subgroups (P=0.03). A modified TNM staging system based on LND ratio was consistently superior to the traditional system in estimating survival measures.


CONCLUSIONS
This multi-institutional study validates the reliability and applicability of LND as a predictor of outcomes in OSCC. Lymph node density can potentially assist in identifying patients with poor outcomes and therefore for whom more aggressive adjuvant treatment is needed.
Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
S G
SG
Patel
M
M
Amit
T C
TC
Yen
C T
CT
Liao
P
P
Chaturvedi
J P
JP
Agarwal
L P
LP
Kowalski
A
A
Ebrahimi
J R
JR
Clark
C R
CR
Cernea
S J
SJ
Brandao
M
M
Kreppel
J
J
Zöller
D
D
Fliss
E
E
Fridman
G
G
Bachar
T
T
Shpitzer
V A
VA
Bolzoni
P R
PR
Patel
S
S
Jonnalagadda
K T
KT
Robbins
J P
JP
Shah
Z
Z
Gil
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult