The Cervical Lymph Node Positive Metastatic Probability Is a Significant Predictor of Survival for Oral Squamous Cell Carcinoma-A Nationwide Study.

Background/objectives: This study aimed to evaluate the prognostic significance of lymph node density (LND) and the log odds of positive lymph nodes (LODDS) in patients with oral squamous cell carcinoma (OSCC) using a nationwide database.

Methods: A retrospective cohort study was conducted using the Taiwan Cancer Registry to identify patients diagnosed with OSCC who underwent surgery for both the primary tumor and neck dissection. Clinicopathological variables were collected, and survival outcomes were analyzed using Cox proportional hazards models. LND was categorized as negative, <0.05, and ≥0.05; LODDS was grouped into four categories: <-4, -4 to -3.5, -3.5 to -2.5, and ≥-2.5.

Results: A total of 1643 female and 15,475 male patients were included, with a mean age of 57.4 years (range, 20-98 years). In multivariable Cox regression analyses, LND and LODDS were identified as independent prognostic factors for overall survival. Compared with patients with negative LND, the hazard ratios for LND < 0.05 and LND ≥0.05 were 2.12 (95% CI, 1.90-2.36) and 3.35 (95% CI, 3.05-3.67), respectively ( < 0.01). Similarly, relative to the lowest LODDS group (<-4), the hazard ratios for the higher categories were 1.51 (95% CI, 1.32-1.74) for -4 to -3.5, 2.30 (95% CI, 2.05-2.57) for -3.5 to -2.5, and 4.32 (95% CI, 3.85-4.86) for ≥-2.5 ( < 0.01).

Conclusions: LND and LODDS are significant prognostic indicators in OSCC. Incorporating these lymph node-based metrics into prognostic models may enhance risk stratification and inform clinical decision-making.