Lymph Node Ratio As a Prognostic Factor in Neck Dissection in Oral Cancer Patients: A Systematic Review and Meta-Analysis

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2022 Sep 23

PMID 36139617

Authors

Zoi Gartagani

Stergios Doumas

Artemis Kyriakopoulou

Panagiota Economopoulou

Theodora Psaltopoulou

Ioannis Kotsantis

Theodoros N Sergentanis

Amanda Psyrri

Affiliations

Soon will be listed here.

Abstract

Many studies have evaluated the clinical implications of lymph node ratio (LNR) as a prognostic factor in patients with oral squamous cell carcinoma (OSCC). The main purpose of this systematic review and meta-analysis was to address LNR as a prognosticator in patients with OSCC. A systematic search was conducted in the following databases: PubMed, EMBASE, Google Scholar, OpenGrey, Cochrane library, and ClinicalTrials.gov, and studies between 2009 and 2020 were sought. The pooled relative risk was calculated along with 95% confidence intervals for the following endpoints: overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), distant metastasis-free survival (DMFS), locoregional disease-free survival (LRDFS), local recurrence-free survival (LRFS), and recurrence-free survival (RFS) according to the random-effects model (Der Simonian-Laird approach). Subgroup and meta-regression analyses were performed as well. Finally, 32 cohort studies were eligible, which included 20,994 patients with OSCC. Patients were subdivided into two categories, group YES (studies that included in their analysis only patients with positive lymph nodes) and group NO (studies that did not exclude LNR = 0 patients). In the group YES, patients with high LNR had shorter OS (RR = 1.68, 95% CI: 1.47-1.91), DFS (RR = 1.68, 95% CI: 1.42-1.99), DSS (RR = 1.94, 95% CI: 1.56-2.42), DMFS (RR = 1.83, 95% CI: 1.13-2.96), LRDFS (RR = 1.55, 95% CI: 1.10-2.20), and LRFS (RR = 1.73, 95% CI: 1.41-2.13) compared to patients with low LNR. In the group NO, patients with high LNR in comparison had shorter OS (RR = 2.38, 95% CI: 1.99-2.85), DFS (RR = 2.04, 95% CI: 1.48-2.81), and DSS (RR = 2.90, 95% CI: 2.35-3.57) compared to patients with low LNR. Based on those findings, LNR might be an independent prognostic factor for OS in patients with OSCC and could be incorporated into future classification systems for better risk stratification.

Citing Articles

Surgical Puzzle: Concurrent Comprehensive Neck Dissection Strategies Unravelling the Mystery of Carcinoma Unknown Primary when Performed with TORS Radical Tonsillectomy and Mucosal Tongue Base Wedge Biopsy in Northern Indian Cohort.

Panda N, Chettuvatti K, Bakshi J Indian J Otolaryngol Head Neck Surg. 2024; 76(6):5201-5208.

PMID: 39559050 PMC: 11569348. DOI: 10.1007/s12070-024-04945-9.

The prognostic values of lymph node ratio for gynecological cancer: a systematic review and meta-analysis.

Chen M, Wang Y, Chen Y, Han L, Zheng A Front Oncol. 2024; 14:1475348.

PMID: 39411125 PMC: 11473349. DOI: 10.3389/fonc.2024.1475348.

Association of Lymph Nodes Positive Rate With the Risk of Recurrence in Patients With Stage T1 Papillary Thyroid Cancer.

Qin C, Cai S, Yin M, Ma B, Shen C, Zhang Y J Endocr Soc. 2024; 8(8):bvae131.

PMID: 39015141 PMC: 11250184. DOI: 10.1210/jendso/bvae131.

Head and Neck Cancer Patients' Survival According to HPV Status, miRNA Profiling, and Tumour Features-A Cohort Study.

Simic I, Bozinovic K, Milutin Gasperov N, Kordic M, Pesut E, Manojlovic L Int J Mol Sci. 2023; 24(4).

PMID: 36834756 PMC: 9959828. DOI: 10.3390/ijms24043344.

Lymph Node Ratio in Head and Neck Cancer with Submental Flap Reconstruction.

Suzuki H, Beppu S, Nishikawa D, Terada H, Sawabe M, Hanai N Biomedicines. 2022; 10(11).

PMID: 36428496 PMC: 9687667. DOI: 10.3390/biomedicines10112923.

References

Lee C, Ho H, Su Y, Lee M, Hung S, Chen Y . The Prognostic Ability of Log Odds of Positive Lymph Nodes in Oral Cavity Squamous Cell Carcinoma. Medicine (Baltimore). 2015; 94(27):e1069. PMC: 4504633. DOI: 10.1097/MD.0000000000001069. View

Suzuki H, Beppu S, Hanai N, Hirakawa H, Hasegawa Y . Lymph node density predicts lung metastases in oral squamous cell carcinoma. Br J Oral Maxillofac Surg. 2015; 54(2):213-8. DOI: 10.1016/j.bjoms.2015.11.002. View

Loganathan P, Sayan A, Hsu D, Paraneetharan S, Ilankovan V . Squamous cell carcinoma of the anterior tongue: is tumour thickness an indicator for cervical metastasis?. Int J Oral Maxillofac Surg. 2016; 46(4):407-412. DOI: 10.1016/j.ijom.2016.11.003. View

Liu D, Chen Y, Deng M, Xie G, Wang J, Zhang L . Lymph node ratio and breast cancer prognosis: a meta-analysis. Breast Cancer. 2013; 21(1):1-9. DOI: 10.1007/s12282-013-0497-8. View

Weckx A, Riekert M, Grandoch A, Schick V, Zoller J, Kreppel M . Time to recurrence and patient survival in recurrent oral squamous cell carcinoma. Oral Oncol. 2019; 94:8-13. DOI: 10.1016/j.oraloncology.2019.05.002. View

Friedman M, Lim J, Dickey W, Tanyeri H, Kirshenbaum G, Phadke D . Quantification of lymph nodes in selective neck dissection. Laryngoscope. 1999; 109(3):368-70. DOI: 10.1097/00005537-199903000-00005. View

Subramaniam N, Balasubramanian D, Kumar N, Murthy S, Vijayan S, Nambiar A . Lymph node staging systems in oral squamous cell carcinoma: A comparative analysis. Oral Oncol. 2019; 97:92-98. DOI: 10.1016/j.oraloncology.2019.08.002. View

Kunzel J, Mantsopoulos K, Psychogios G, Grundtner P, Koch M, Iro H . Lymph node ratio as a valuable additional predictor of outcome in selected patients with oral cavity cancer. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 117(6):677-84. DOI: 10.1016/j.oooo.2014.02.032. View

Ganly I, Patel S, Shah J . Early stage squamous cell cancer of the oral tongue--clinicopathologic features affecting outcome. Cancer. 2011; 118(1):101-11. DOI: 10.1002/cncr.26229. View

10.

Troeltzsch M, Haidari S, Boser S, Troeltzsch M, Probst F, Ehrenfeld M . What Factors Are Associated With Regional Recurrence After Operative Treatment of Oral Squamous Cell Carcinoma?. J Oral Maxillofac Surg. 2018; 76(12):2650-2659. DOI: 10.1016/j.joms.2018.07.005. View

11.

Ebrahimi A, Zhang W, Gao K, Clark J . Nodal yield and survival in oral squamous cancer: Defining the standard of care. Cancer. 2011; 117(13):2917-25. DOI: 10.1002/cncr.25834. View

12.

Sayed S, Sharma S, Rane P, Vaishampayan S, Talole S, Chaturvedi P . Can metastatic lymph node ratio (LNR) predict survival in oral cavity cancer patients?. J Surg Oncol. 2013; 108(4):256-63. DOI: 10.1002/jso.23387. View

13.

Almangush A, Makitie A, Triantafyllou A, de Bree R, Strojan P, Rinaldo A . Staging and grading of oral squamous cell carcinoma: An update. Oral Oncol. 2020; 107:104799. DOI: 10.1016/j.oraloncology.2020.104799. View

14.

Ong W, Zhao R, Lui B, Tan W, Ebrahimi A, Clark J . Prognostic significance of lymph node density in squamous cell carcinoma of the tongue. Head Neck. 2015; 38 Suppl 1:E859-66. DOI: 10.1002/hed.24113. View

15.

Ebrahimi A, Clark J, Zhang W, Elliott M, Gao K, Milross C . Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma. Head Neck. 2010; 33(9):1245-51. DOI: 10.1002/hed.21600. View

16.

Chow T, Kwan W, Fung S, Ho L . Prognostic value of lymph node density in buccal squamous cell carcinoma. Am J Otolaryngol. 2017; 38(5):529-532. DOI: 10.1016/j.amjoto.2017.05.001. View

17.

Safi A, Kauke M, Grandoch A, Nickenig H, Zoller J, Kreppel M . The importance of lymph node ratio for patients with mandibular infiltration of oral squamous cell carcinoma. J Craniomaxillofac Surg. 2018; 46(6):1007-1012. DOI: 10.1016/j.jcms.2018.03.021. View

18.

Dhanuthai K, Rojanawatsirivej S, Thosaporn W, Kintarak S, Subarnbhesaj A, Darling M . Oral cancer: A multicenter study. Med Oral Patol Oral Cir Bucal. 2017; 23(1):e23-e29. PMC: 5822535. DOI: 10.4317/medoral.21999. View

19.

Jin W, Zhu Z, Wu Y, Ding X, Wu H, Song X . Prognostic value of log odds of positive lymph nodes in patients with resectable oral squamous cell carcinoma. Oral Oncol. 2020; 108:104709. DOI: 10.1016/j.oraloncology.2020.104709. View

20.

Teng J, Abdygametova A, Du J, Ma B, Zhou R, Shyr Y . Bayesian Inference of Lymph Node Ratio Estimation and Survival Prognosis for Breast Cancer Patients. IEEE J Biomed Health Inform. 2019; 24(2):354-364. DOI: 10.1109/JBHI.2019.2943401. View