Lymph node density in oral cavity cancer: Results of the International Consortium for Outcomes Research

S. G. Patel, M. Amit, T. C. Yen, C. T. Liao, P. Chaturvedi, J. P. Agarwal, L. P. Kowalski, A. Ebrahimi, J. R. Clark, C. R. Cernea, S. J. Brandao, M. Kreppel, J. Zöller, D. Fliss, E. Fridman, G. Bachar, T. Shpitzer, V. A. Bolzoni, P. R. Patel, S. JonnalagaddaK. T. Robbins, J. P. Shah, Z. Gil*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background:Lymph node density (LND) has previously been reported to reliably predict recurrence risk and survival in oral cavity squamous cell carcinoma (OSCC). This multicenter international study was designed to validate the concept of LND in OSCC.Methods:The study included 4254 patients diagnosed as having OSCC. The median follow-up was 41 months. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control and distant metastasis rates were calculated using the Kaplan-Meier method. Lymph node density (number of positive lymph nodes/total number of excised lymph nodes) was subjected to multivariate analysis.Results:The OS was 49% for patients with LND≤0.07 compared with 35% for patients with LND>0.07 (P<0.001). Similarly, the DSS was 60% for patients with LND≤0.07 compared with 41% for those with LND>0.07 (P<0.001). Lymph node density reliably stratified patients according to their risk of failure within the individual N subgroups (P=0.03). A modified TNM staging system based on LND ratio was consistently superior to the traditional system in estimating survival measures.Conclusion:This multi-institutional study validates the reliability and applicability of LND as a predictor of outcomes in OSCC. Lymph node density can potentially assist in identifying patients with poor outcomes and therefore for whom more aggressive adjuvant treatment is needed.

Original languageEnglish
Pages (from-to)2087-2095
Number of pages9
JournalBritish Journal of Cancer
Issue number8
StatePublished - 15 Oct 2013
Externally publishedYes


FundersFunder number
ICRF Barbara S Goodman2011-601-BGPC
Rambam Medical Center
Weizmann Institute
United States-Israel Binational Science Foundation
Israel Cancer Association20090068
Israel Science Foundation
Ministry of Health, State of Israel3-7355


    • lymph node density
    • oral cavity
    • squamous
    • survival


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