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Poster Award

Head & Neck

(24) Prognostic Value of Lymph Node Yield and Lymph Node Ratio in Patients With Head and Neck Squamous Cell Carcinoma: A Retrospective Cohort Study

Thursday, September 18, 2025
2:30 PM - 4:00 PM EDT

    Poster Presenter(s)

  • Ali Abdolrahmani, DDS, MPH

    Dental Student
    School of Dentistry, University of Michigan, Ann Arbor, Michigan
    Ann Arbor, Michigan, United States

    • Co-Author(s)

  • NK

    Neda Kardouni Khoozestani, DDS

    Oral and Maxillofacial Pathology Resident
    School of Dental Medicine, University of Pittsburgh
    Pittsburgh, Pennsylvania, United States

  • MS

    Mohammad Shirkhoda, MD

    Associate Professor of Surgical Oncology
    Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
    Tehran, Tehran, Iran

  • MM

    Mahsa Mortaja, MD

    Postdoctoral Scholar, Radiation Medicine and Applied Science
    Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
    La Jolla, California, United States

  • SM

    Sepideh Mehravar, MD

    Research Associate
    Medically Associated Science and Technology (MAST) Program, Cedars Sinai Medical Center, Los Angeles, CA, USA
    Los Angeles, California, United States

  • FT

    Farzad Teymouri, MD

    Internal Medicine Resident
    Department of Medicine, Eisenhower Health, Rancho Mirage, CA, USA
    Rancho Mirage, California, United States

Disclosure(s):
Ali Abdolrahmani, DDS, MPH: No financial relationships to disclose
Abstract: Lymph node involvement has been shown to be a critical prognostic factor in head and neck squamous cell carcinoma (HNSCC). Lymph node yield (LNY), which is the total number of lymph nodes retrieved, and lymph node ratio (LNR), which is the ratio of positive lymph nodes to the total removed, are measurable indicators with promising prognostic significance. This study aimed to evaluate the prognostic significance of LNY and LNR in predicting disease-free survival in patients with HNSCC undergoing selective neck dissection (SND).
A total of 226 clinically node-negative (N0) HNSCC patients who underwent SND between 2010 and 2019 at the Cancer Institute of Tehran University of Medical Sciences (TUMS), the largest nationwide referral cancer center in Iran, were included. Patient demographic data and clinicopathologic parameters were described. LNY and LNR were determined from pathology records with re-evaluation of slides where needed. Patients were followed for disease-free and disease-specific survival. Survival analysis was conducted using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to identify independent predictors of relapse-free survival. A P value < .05 was considered statistically significant.
The median follow-up was 24.02 months (range: 8.46–122.79 months). The two-year relapse-free survival rate was 80.3% (SE = 3.1%). According to simple Cox regression analysis, age, positive margin, positive occult metastatic lymph nodes, LNY, LNR, and distant metastasis were significantly related to disease-free survival. Multivariate analysis identified only LNR (HR = 3.54, P < .001) and the presence of metastasis (HR = 2.13, P = .04) as significant predictors of reduced disease-free survival.
This study confirms that both LNY and LNR can potentially serve as important prognostic factors in oral cavity and oropharyngeal SCC. Removing more than 20 lymph nodes improves survival outcomes, while an LNR exceeding 10% significantly worsens prognosis. Incorporating these parameters into surgical planning and postoperative assessment may enhance risk stratification and treatment decisions. Further multi-center studies with longer-term follow-up are recommended to validate these findings.

1. Liu, X. C., Ma, S. R., Shi, S., Zhao, Y. F., & Jia, J. (2022). Prognostic significance of lymph node ratio in patients with squamous cell carcinoma of the floor of the mouth. International journal of oral and maxillofacial surgery, 51(3), 307–313. https://doi.org/10.1016/j.ijom.2021.07.001

2. Ong, W., Zhao, R., Lui, B., Tan, W., Ebrahimi, A., Clark, J. R., Soo, K. C., Tan, N. C., Tan, H. K., & Iyer, N. G. (2016). Prognostic significance of lymph node density in squamous cell carcinoma of the tongue. Head & neck, 38 Suppl 1, E859–E866. https://doi.org/10.1002/hed.24113