Nodal ratio as an independent predictor of survival in squamous cell carcinoma of the oral cavity

Background. The association between nodal ratio and survival in oral cavity carcinomas has recently been proposed, but no prospective evaluations exist. Methods. We sought to determine, using an institutional database, whether nodal ratio impacts survival in node-positive oral cavity squamous cell carcinoma. Results. Between 1994 and 2004, 143 new diagnoses of N_1-2 squamous cell carcinoma of the oral cavity were identified. The mean number of nodes identified was 41.6, and the mean nodal ratio was 9%. Nodal ratio was strongly statistically associated with overall and disease-specific survival in both univariate and multivariate analyses. No other prognostic indicator maintained that degree of statistical significance. Patients could be stratified into low (0% to 6%), moderate (6% to 13%), and high-risk (>13%) groups based on nodal ratio. Conclusions. In squamous cell carcinoma of the oral cavity, an increased nodal ratio is a strong predictor of decreased survival. Risk of death can be stratified by nodal ratio.