Li Meng-Hua, Hu Yu-Jun, Shan Hui-Min, Gao Xian-Lu, Huang Qi-Yu, Zhao Wen-Yan, Zhang Shi-Ting, Zhang Ying, Chen Shu-Wei, Song Ming
Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, China.
State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, China; Department of Radiology, Sun Yat-Sen University Cancer Center, China.
Oral Oncol. 2025 Feb;161:107193. doi: 10.1016/j.oraloncology.2025.107193. Epub 2025 Jan 18.
To analyze the role of lymph node level ratio (LNLR) in predicting prognosis and the benefits of postoperative radiotherapy (PORT) in patients with pathological N1 (pN1) head and neck squamous cell carcinoma (HNSCC).
Patients with pN1 HNSCC from January 2011 to February 2021 were included. Patients were grouped by the LNLR, lymph node yield (LNY), and lymph node ratio (LNR) and were analyzed with the Kaplan-Meier method and multivariate Cox model.
This study identified 310 patients. Time-dependent receiver operating characteristic analyses showed superior prognostic ability for LNLR in comparison with LNY and LNR. Patients with an LNLR ≤ 5.25 had the worst survival. Multivariate regressions demonstrated larger hazard ratios (HRs) and a higher concordance index for the LNLR model versus the LNY and LNR models. The HRs (95 % confidence interval) for a LNLR ≤ 5.25 were 2.46 (1.71-3.54, p < 0.001) for DFS, 1.95 (1.38-2.75, p < 0.001) for OS, 2.25 (1.53-3.29, p < 0.001) for DSS. Furthermore, postoperative radiotherapy-related significant improvement in survival was observed exclusively in the LNLR ≤ 5.25 subgroup.
The LNLR is a more robust quality indicator for neck dissection. An LNLR of ≤ 5.25 significantly compromises survival and indicates the need for PORT in patients with pN1 HNSCC.
分析淋巴结水平比值（LNLR）在预测病理N1（pN1）期头颈部鳞状细胞癌（HNSCC）患者预后中的作用以及术后放疗（PORT）的获益情况。
纳入2011年1月至2021年2月期间的pN1期HNSCC患者。根据LNLR、淋巴结收获数（LNY）和淋巴结比值（LNR）对患者进行分组，并采用Kaplan-Meier法和多变量Cox模型进行分析。
本研究共纳入310例患者。时间依赖性受试者工作特征分析显示，与LNY和LNR相比，LNLR具有更好的预后预测能力。LNLR≤5.25的患者生存情况最差。多变量回归分析表明，与LNY和LNR模型相比，LNLR模型的风险比（HR）更大，一致性指数更高。LNLR≤5.25时，无病生存期（DFS）的HR（95%置信区间）为2.46（1.71-3.54，p<0.001），总生存期（OS）为1.95（1.38-2.75，p<0.001），疾病特异性生存期（DSS）为2.25（1.53-3.29，p<0.001）。此外，仅在LNLR≤5.25亚组中观察到术后放疗与生存的显著改善。
LNLR是一种更强有力的颈部清扫质量指标。LNLR≤5.25显著影响生存，并表明pN1期HNSCC患者需要进行PORT。
