Prognostic Significance of Lymph Node Parameters in Laryngeal Cancer After Laryngectomy

OBJECTIVE: The aim of this study was to evaluate the prognostic significance of lymph node yield, lymph node positivity ratio, and metastatic lymph node count in patients with laryngeal cancer undergoing laryngectomy with neck dissection, and to identify optimal cutoff values for these parameters using receiver operating characteristic (ROC) curve analysis. METHODS: This retrospective study included 48 patients who underwent partial or total laryngectomy with bilateral neck dissection at a tertiary referral center between January 2015 and December 2019. Demographic characteristics, TNM stage, lymph node parameters, pathological risk factors, recurrence, and mortality were analyzed. Neck dissection primarily bilateral involved cervical levels II-IV, with additional levels dissected when clinically or radiologically indicated. RESULTS: Metastatic lymph node count was significantly associated with overall survival in both univariate and multivariable Cox analyses (HR: 1.344, p < 0.001; HR: 1.348, p = 0.007, respectively). An optimal lymph node ratio (LNR) cutoff of 0.045 was identified. LNR ≥ 0.045 was associated with poorer survival (log-rank p = 0.006) and increased mortality in univariate analysis (HR: 4.815; p = 0.013), but not in multivariable analysis (p = 0.325). CONCLUSIONS: In conclusion, the findings of this study demonstrate that lymph node-based parameters are important prognostic indicators in laryngeal cancer. Among these, the absolute number of metastatic lymph nodes emerged as the most robust and biologically meaningful predictor of overall survival.