Re-evaluating Lymph Node Yield, Lymph Node Ratio, and the number of metastatic nodes as prognostic factors in oral cavity squamous cell carcinoma.

OBJECTIVE: Previous studies of Lymph Node Yield (LNY) for neck dissection in Oral Cavity Squamous Cell Carcinoma (OCSCC) have shown LNY of 18 or more lymph nodes to be of prognostic value. This study aims to evaluate the prognostic implications of LNY, number of metastatic nodes, and Lymph Node Ratio (LNR) in clinical N0 OCSCC. METHODS: We retrospectively analyzed 118 patients who underwent elective neck dissection for OCSCC at Rabin Medical Center (2000-2020). Demographic, clinical, pathological, and surgical data were collected. We examined the prognostic significance of LNY cutoffs (18 and 13), number of positive nodes, and LNR on disease-free and overall survival. RESULTS: The mean LNY was 19.5 +/- 11.3 nodes, with a lymph node metastasis rate of 31.3 %. Statistical analysis showed that neither 18 nor 13 lymph nodes had significant prognostic value for recurrence or survival. The mean LNR was 4.52 % +/- 11.3 %, with higher LNR values (>3.4 %) significantly associated with increased recurrence (p = 0.003) and reduced survival intervals (p = 0.003). Cox regression analysis further confirmed that both elevated LNR and the presence of more than two metastatic lymph nodes were independently associated with increased mortality. CONCLUSIONS: Our findings challenge the commonly cited LNY threshold of 18, as no specific LNY cutoff conferred significant survival benefits. Instead, LNR emerged as a superior prognostic marker, correlating strongly with overall survival and locoregional control. Incorporating LNR into prognostic models may enhance risk stratification and guide clinical decision-making in OCSCC management.