The relevance of the lymph node ratio as predictor of prognosis is higher in HPV-negative than in HPV-positive oropharyngeal squamous cell carcinoma

Clin Otolaryngol. 2018 Feb;43(1):192-198. doi: 10.1111/coa.12938. Epub 2017 Aug 14.


Objectives: Lymph node ratio (LNR) is an established predictor in different entities of carcinoma, including head and neck malignancies. In oropharyngeal squamous cell carcinoma (OPSCC), lymph node involvement differs between human papilloma virus (HPV)-positive and HPV-negative tumours. Herein, we evaluate the impact of HPV association on the concept of LNR.

Methods: 88 surgically treated patients were included in this retrospective chart review. HPV-positive and HPV-negative OPSCC were evaluated for prediction of outcome by LNR separately. The endpoints were 5-year overall survival (OS) and recurrence-free survival (RFS).

Results: The OS of all patients was 60.1%. In univariate analysis, LNR was a significant predictor of overall survival rate (P=.008) in OPSCC independently of the HPV status, as well as extracapsular spread (ECS). T-classification was only a significant predictor in the univariate analysis in HPV-positive OPSCC carcinoma. However, in the multivariate analysis LNR remained predictor of prognosis in all OPSCC and in HPV-negative OPSCC. In patients with HPV-positive OPSCC, only T-classification reached significance to predict OS.

Conclusion: Prognosis of primarily operated HPV-positive patients might be more dependent on the extent of primary tumour site, whereas prognosis of HPV-negative patients is based more on cervical metastatic spread, represented by LNR.

Keywords: cancer; lymph node density; lymph node ratio; oropharyngeal squamous carcinoma; overall survival; recurrence-free survival.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / secondary*
  • Carcinoma, Squamous Cell / surgery
  • Female
  • Germany / epidemiology
  • Humans
  • Incidence
  • Lymph Nodes / diagnostic imaging*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neck
  • Neoplasm Staging*
  • Oral Surgical Procedures
  • Oropharyngeal Neoplasms / diagnosis*
  • Oropharyngeal Neoplasms / epidemiology
  • Oropharyngeal Neoplasms / surgery
  • Papillomaviridae*
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / virology
  • Prognosis
  • Retrospective Studies
  • Survival Rate / trends
  • Tomography, X-Ray Computed