title: Lymph node ratio influence on risk of head and neck cancer locoregional recurrence after initial surgical resection: implications for adjuvant therapy.
abstract: BACKGROUND
  The purpose of this study was to determine if lymph node ratio is associated with locoregional recurrence for patients with oral cavity or laryngeal cancer treated with initial surgical management.
  
  
  METHODS
  The study included 350 patients with oral cavity (73%) or laryngeal cancer (27%) who underwent initial surgery. All analyses were multivariable, adjusting for primary site, pathologic prognostic factors, and adjuvant therapy.
  
  
  RESULTS
  Lymph node ratio was significantly associated with locoregional recurrence, in which each 1% increase in lymph node ratio had an adjusted hazard ratio (HR) for locoregional recurrence of 1.02 (95% confidence interval [CI], 1.002-1.042; p = .05). Lymph node ratio was also associated with OS, in which each 1% increase in lymph node ratio had an adjusted HR for death of 1.028 (95% CI, 1.012-1.045; p = .001).
  
  
  CONCLUSIONS
  Adjusting for pathologic factors and adjuvant therapy, lymph node ratio was found to be an independent prognostic factor for locoregional recurrence and overall survival (OS). Patients with lymph node ratio ≥20% are at high risk of locoregional recurrence and death, and may be considered for adjuvant chemoradiation.
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Roshan S
authors.initials: RS
authors.lastname: Prabhu
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Sheela
authors.initials: S
authors.lastname: Hanasoge
authors.affiliation: Department of Pathology, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Magliocca
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: William A
authors.initials: WA
authors.lastname: Hall
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas.
authors.forename: Susie A
authors.initials: SA
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Higgins
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Nabil F
authors.initials: NF
authors.lastname: Saba
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Mark
authors.initials: M
authors.lastname: El-Deiry
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: William
authors.initials: W
authors.lastname: Grist
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: J Trad
authors.initials: JT
authors.lastname: Wadsworth
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
mesh_terms: D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: adjuvant chemoradiotherapy; adjuvant radiotherapy; head and neck cancer; larynx cancer; oral cavity cancer; otolaryngology