title: Is lymph-node ratio a superior predictor than lymph node status for recurrence-free and overall survival in patients with head and neck squamous cell carcinoma?
abstract: BACKGROUND
  TNM status is questioned as an exact predictor of survival in different tumour entities. Recently, lymph node ratio (LNR) has been described as a predictor of survival in patients with HNSCC. The purpose of this study was to evaluate to which degree LNR could be used as a more accurate predictor than TNM staging?
  
  
  METHODS
  A total of 291 patients, with a follow-up of at least 3 years, were analyzed using log-rank statistic, univariate and multivariate data analyzes, and p values, for prediction of lymph node ratio on overall and recurrence-free survival.
  
  
  RESULTS
  Survival differed significantly if patients were stratified for LNR. Impact of LNR on survival was significantly different even in patients with extracapsular spread. Patients with pN0 had no survival benefit compared with patients with pN1 or higher with a LNR lower than 6 %.
  
  
  CONCLUSIONS
  LNR is a prognostic tool in patients with a lymph node status pN0-pN2b. LNR remained significant even in patients with extracapsular spread, contrary to TNM status. With LNR, stratification for high-risk patients (higher than 6 % LNR) can be evaluated easily. We would suggest using LNR in the clinical routine.
authors.affiliation: Department of General Otorhinolaryngology, Head and Neck Surgery, University Hospital of Graz, Graz, Austria, sabine.reinisch@medunigraz.at.
authors.forename: Sabine
authors.initials: S
authors.lastname: Reinisch
authors.forename: Astrid
authors.initials: A
authors.lastname: Kruse
authors.forename: Marius
authors.initials: M
authors.lastname: Bredell
authors.forename: Heinz-Theo
authors.initials: HT
authors.lastname: Lübbers
authors.forename: Thomas
authors.initials: T
authors.lastname: Gander
authors.forename: Martin
authors.initials: M
authors.lastname: Lanzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate