TY - JOUR

T1 - Prognostic Value of Lymph Node Yield, Lymph Node Density, and pN in Oral Cancer

AU - Stampe, Helene

AU - Jakobsen, Kathrine Kronberg

AU - Tvedskov, Jesper Filtenborg

AU - Wessel, Irene

AU - Kiss, Katalin

AU - Friborg, Jeppe

AU - Andersen, Amanda Oester

AU - Grønhøj, Christian

AU - von Buchwald, Christian

AU - Christensen, Anders

N1 - Publisher Copyright: © American Academy of Otolaryngology–Head and Neck Surgery Foundation 2022.

PY - 2023

Y1 - 2023

N2 - Objectives: To investigate thresholds for lymph node yield (LNY), lymph node density (LND), and pN in patients with oral squamous cell carcinoma in relation to previous findings in the literature. Study Design: Retrospective register-based study. Setting: Copenhagen Oral Cavity Squamous Cell Carcinoma database. Methods: Appropriate thresholds for LNY, LND, and pN were determined by areas under the curve and subsequently subjected to multivariate analysis. Five-year overall survival and 3-year recurrence-free survival were determined by Kaplan-Meier survival curves. Results: In total, 413 patients diagnosed with oral squamous cell carcinoma were included. In the pN0 cohort, no superior/prognostic LNY cutoff values were detected. In the pN+ cohort, areas under the curve determined thresholds of LNY, LND, and pN to be 21 nodes, 5%, and 3 metastases, respectively. The 5-year overall survival was 52% for patients with LNY ≥21 vs 38% for patients with LNY <21 (hazard ratio [HR], 1.49; 95% CI, 1.05-2.11; P <.05), 60% for patients with LND ≤5% vs 38% for patients with LND >6% (HR, 1.63; 95% CI, 1.03-2.57; P <.05), and 43% for patients with pN <3 vs 26% for patients with pN ≥3 (HR, 1.40; 95% CI, 1.04-2.15; P <.05). Conclusions: Increased nodal yield, decreased LND, and decreasing number of pN were associated with significantly improved survival outcomes. LNY might serve as a prognosticator of survival as well as a surgical quality indicator. LND may have implications as a tool in cancer staging and treatment planning.

AB - Objectives: To investigate thresholds for lymph node yield (LNY), lymph node density (LND), and pN in patients with oral squamous cell carcinoma in relation to previous findings in the literature. Study Design: Retrospective register-based study. Setting: Copenhagen Oral Cavity Squamous Cell Carcinoma database. Methods: Appropriate thresholds for LNY, LND, and pN were determined by areas under the curve and subsequently subjected to multivariate analysis. Five-year overall survival and 3-year recurrence-free survival were determined by Kaplan-Meier survival curves. Results: In total, 413 patients diagnosed with oral squamous cell carcinoma were included. In the pN0 cohort, no superior/prognostic LNY cutoff values were detected. In the pN+ cohort, areas under the curve determined thresholds of LNY, LND, and pN to be 21 nodes, 5%, and 3 metastases, respectively. The 5-year overall survival was 52% for patients with LNY ≥21 vs 38% for patients with LNY <21 (hazard ratio [HR], 1.49; 95% CI, 1.05-2.11; P <.05), 60% for patients with LND ≤5% vs 38% for patients with LND >6% (HR, 1.63; 95% CI, 1.03-2.57; P <.05), and 43% for patients with pN <3 vs 26% for patients with pN ≥3 (HR, 1.40; 95% CI, 1.04-2.15; P <.05). Conclusions: Increased nodal yield, decreased LND, and decreasing number of pN were associated with significantly improved survival outcomes. LNY might serve as a prognosticator of survival as well as a surgical quality indicator. LND may have implications as a tool in cancer staging and treatment planning.

KW - lymph node density

KW - lymph node yield

KW - oral squamous cell carcinoma

KW - pN

KW - prognostic value

U2 - 10.1177/01945998221123927

DO - 10.1177/01945998221123927

M3 - Journal article

C2 - 36066971

AN - SCOPUS:85138415953

VL - 169

SP - 276

EP - 285

JO - Otolaryngology - Head and Neck Surgery

JF - Otolaryngology - Head and Neck Surgery

SN - 0194-5998

IS - 2

ER -