The lymph node ratio is a prognostic factor for survival in laryngeal and hypopharyngeal squamous cell carcinoma

The lymph-node yield and the lymph-node ratio have emerged as important prognostic tools for head and neck cancer. These metrics are an index of disease burden, but also of quality standards. The objective of the present study was to examine the impact of different lymph-node yield cut-offs and the lymph-node ratio on 10-year recurrence-free interval and overall-survival.

A single center cohort study was carried out over a 10-year period (2013-2023). A total of 157 patients met inclusion criteria and were available for analysis. Patients met inclusion criteria if they underwent a laryngectomy or laryngo-pharyngectomy for a squamous cell carcinoma of the larynx or hypopharynx. Data collected included pathological factors, surgical characteristics, margin status, recurrence and overall survival.

Median follow-up was 64 ± 9 months. The 10-year recurrence-free interval and overall survival were 63 % and 45 %, respectively. Univariate analysis identified extra-nodal extension, salvage surgery, and lymph node ratio >0.05 as negative prognosticators for the recurrence-free interval and overall survival (all p < 0.05). Higher lymph node yield (>18 and >26 nodes/neck) was associated with improved recurrence free interval (HR 0.53 and 0.45, respectively). Multivariate analysis confirmed extra-nodal extension (HR 3.53), salvage surgery (HR 2.49), and lymph node ratio >0.05 (HR 3.43) as independent predictors of worse recurrence free interval. Extra-nodal extension and lymph node ratio >0.05 remained independently associated with worse overall survival.

A lymph node ratio of >0.05 is an independent adverse prognostic factor for both recurrence-free and overall survival, particularly in the context of salvage surgery and extra-nodal extension. These findings support incorporation of nodal metrics into risk stratification frameworks for advanced laryngeal and hypopharyngeal cancers.