title: Impact of nodal ratio on survival in recurrent nasopharyngeal carcinoma.
abstract: BACKGROUND
  The purpose of this study was to investigate if nodal ratio has a prognostic role in the survival of patients with recurrent nasopharyngeal carcinoma (NPC) in the neck.
  
  
  METHODS
  Patients with recurrent NPC in the neck who were treated in Queen Mary Hospital from 2000 to 2011 were identified. Clinical data, pathological results, and survival outcome were analyzed.
  
  
  RESULTS
  Only nodal ratio remained as a statistically significant predictor in multivariate analysis for nodal recurrence (p = .045) and nodal recurrence-free survival (p = .010). All other predictors lost significance when compared with each other and with nodal ratio. Nodal ratio was also a significant predictor for overall survival (OS) in univariate analysis (p = .001) but lost its significance in multivariate analysis. The cutoff points 10% and 15% effectively stratified the patients into 3 risk groups (p = .02).
  
  
  CONCLUSIONS
  In patients with NPC with neck recurrence, nodal ratio (the ratio of positive nodes to the total number of nodes examined) is a strong predictor of further nodal recurrence and nodal recurrence-free survival. Nodal ratio also impacts the OS but loses its significance in multivariate analysis, including concurrent local recurrence. Stratification of patients into low, medium, and high-risk groups according to nodal ratio may have a potential role in guiding therapeutic decision-making. Therefore, further exploration in this area is warranted.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Richie Chiu-Lung
authors.initials: RC
authors.lastname: Chan
authors.forename: Jimmy Yu Wai
authors.initials: JY
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: neck recurrence; nodal ratio; nodal recurrence; recurrent nasopharyngeal carcinoma; survival