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Related Experiment Video

Updated: Jan 20, 2026

Comparison of Predictive Performance of Three Lymph Node Staging Systems in Colorectal Signet Ring Cell Carcinoma Based on Machine Learning Model
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Lymph node staging systems in oral squamous cell carcinoma: A comparative analysis.

Narayana Subramaniam1, Deepak Balasubramanian1, Narender Kumar2

  • 1Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

Oral Oncology
|August 30, 2019
PubMed
Summary

The number of positive lymph nodes (PN) and lymph node ratio (LNR) better predict survival in oral squamous cell carcinoma (OSCC) than the AJCC 8th edition staging system. These simpler metrics offer improved prognostic accuracy for OSCC patients.

Keywords:
AJCC 8th editionLymph node ratioLymph node stagingNumber of positive lymph nodesOral cancerOral squamous cell carcinomaSurvival

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Area of Science:

  • Oncology
  • Head and Neck Surgery
  • Cancer Staging

Background:

  • The 8th edition of the American Joint Committee on Cancer (AJCC) staging system introduced a new nodal staging for head and neck cancers.
  • Existing alternative nodal staging systems have not been comprehensively compared against the current AJCC 8th edition (AJCC8) system.

Purpose of the Study:

  • To evaluate and compare the prognostic accuracy of different nodal staging systems for oral squamous cell carcinoma (OSCC).
  • To determine which staging system best predicts disease-free survival (DFS) and overall survival (OS) in OSCC patients.

Main Methods:

  • Retrospective analysis of 643 OSCC patients treated between 2004 and 2014.
  • Nodal staging was assessed using AJCC 8th edition (AJCC8), number of positive lymph nodes (PN), log odds of positive lymph nodes (LODDS), and lymph node ratio (LNR).
  • Survival analyses (DFS and OS) were performed, comparing staging systems based on hazard consistency, discrimination, explained variation, and likelihood.

Main Results:

  • The number of positive lymph nodes (PN) and lymph node ratio (LNR) demonstrated superior prediction of OS and DFS compared to other systems.
  • The AJCC 8th edition (AJCC8) system showed limited discrimination between substages of pN2.
  • PN and LNR provided the most accurate prognostic predictions for OSCC patients in this cohort.

Conclusions:

  • Number of positive lymph nodes (PN) and lymph node ratio (LNR) are more accurate predictors of survival for oral squamous cell carcinoma (OSCC) patients.
  • These metrics offer a more reliable prognostic tool than the current AJCC 8th edition staging system for OSCC.