title: Prognostic Significance of Lymph Node Density in Patients with Hypopharyngeal Squamous Cell Carcinoma.
abstract: BACKGROUND
  Lymph node density (LND) is more useful than the TNM classification in predicting survival after surgery for many cancers. The purpose of this study was to clarify independent prognostic factors for hypopharyngeal squamous cell carcinoma (HPSCC) and broaden the staging system to improve its predictive value.
  
  
  METHODS
  The present study included 105 patients with HPSCC treated with hypophagectomy and neck dissection between 1993 and 2014.
  
  
  RESULTS
  The median LND in patients with HPSCC was 0.060 (range 0.026-0.620). We found a significant difference in LND values between patients with and without recurrence (0.063 vs. 0.030, respectively; p = 0.001). The cutoff value of LND for recurrence was 0.055, with a sensitivity of 68% and specificity of 71%. Cervical lymph node metastasis, advanced pathologic T stage, lymphovascular invasion, LND ≥0.055, and extracapsular spread had significant adverse effects on 5-year overall and disease-specific survival in a univariate analysis. Multivariate analysis confirmed a significant association between 5-year overall survival and LND ≥0.055 [hazard ratio (HR) 2.19; 95% confidence interval (CI) 1.06-4.51; p = 0.035] and extracapsular spread (HR 2.47; 95% CI 1.09-5.61; p = 0.030). Furthermore, LND ≥0.055 (HR 2.30; 95% CI 1.07-4.93; p = 0.034) and extracapsular spread (HR 2.95; 95% CI 1.20-7.29; p = 0.019) were associated with 5-year, disease-specific survival.
  
  
  CONCLUSIONS
  The median LND cutoff values ≥0.055 are associated with a greater risk of recurrence and survival in patients with HPSCC.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 505 Banpodong Seochogu Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Joo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 505 Banpodong Seochogu Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Kwang-Jae
authors.initials: KJ
authors.lastname: Cho
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 505 Banpodong Seochogu Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Sang-Yeon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 505 Banpodong Seochogu Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. entkms@catholic.ac.kr.
authors.forename: Min-Sik
authors.initials: MS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate