Lymph node ratio is of limited value for the decision-making process in the treatment of patients with laryngeal cancer

The lymph node ratio (LNR) combines two types of information-about the extent of neck dissection and about the extent of the pathological examination of the specimen-and thus represents an interesting variable for risk assessment in patients with head and neck cancer. This retrospective study with data from January 1, 1980, to December 31, 2010, evaluates the utility of the LNR as a potential prognostic predictor in patients with laryngeal squamous cell carcinoma (LSCC). A total of 202 consecutive patients with regionally metastasized LSCC who underwent primary surgery with or without adjuvant treatment were included. The mean follow-up period was 4.4 years. The LNR was calculated as the ratio of positive nodes to the total number of nodes removed during neck dissection. Multivariate analysis was carried out. Peak values as averaged clusters of individual LNRs were registered at three points (LNR 0.05, 0.07, and 0.09). LNR 0.09 was a significant prognostic parameter in the Cox regression model (P = 0.007). Patients with an LNR > 0.09 had a hazard ratio of 2.065 for a disease-specific survival event in comparison with LNR < 0.09. The most accurate LNR for LSCC is expected to be located in the range of 0.08-0.1. The LNR seems to be of limited value for the decision-making process in the treatment of patients with LSCC, in comparison with other locations. Prospective trials will be required in order to allow evidence-based recommendations for treatment decisions based on the LNR.