Prognostic significance of nodal ratio in cutaneous squamous cell carcinoma of the head and neck

Aviram Mizrachi*, Tuvia Hadar, Naomi Rabinovics, Thomas Shpitzer, Dan Guttman, Raphael Feinmesser, Gideon Bachar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The TNM classification is not specific for head and neck skin cancer and makes no allowance for disease extent. Studies have shown that the relative number of metastatic-to-examined lymph nodes, termed the Nodal ratio, is a reliable independent prognosticator in several types of cancer. The study was designed as a retrospective analysis in a university affiliated tertiary care center setting. The files of all patients (n = 71) with cutaneous head and neck squamous cell carcinoma and regional lymph node metastasis who attended a tertiary medical center between 1990 and 2008 were reviewed for clinical variables and outcome, and Nodal ratio was calculated. Data were analyzed for impact on survival. On multivariate analysis Nodal ratio and age were found to be significant predictors of overall survival. The N-ratio was the only significant predictor of disease-specific survival. Age, type of treatment (selective/modified neck dissection), pathologic N stage, and radiotherapy had no effect. The Nodal ratio is a potentially valuable prognostic index in cutaneous squamous cell carcinoma. The minimal number of nodes that need to be excised has to be determined.

Original languageEnglish
Pages (from-to)647-653
Number of pages7
JournalEuropean Archives of Oto-Rhino-Laryngology
Issue number2
StatePublished - Feb 2013


  • Cutaneous squamous cell carcinoma
  • Lymph node metastasis
  • Nodal ratio
  • Radiotherapy


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