Prognostic capacity of the weighted lymph node ratio in head and neck squamous cell carcinoma patients treated with salvage neck dissection



The aim of the study was to assess the prognostic capacity of the recently described weighted lymph node ratio (WLNR) in patients with head and neck squamous cell carcinoma (HNSCC) who undergo salvage neck dissection for regional recurrence.

Material and methods

We retrospectively studied 197 adult patients with head and neck squamous cell carcinoma treated with salvage neck dissection from 1990 to 2017.


The mean value for the WLNR for all patients was 26.2%. We established a classification based on the WLNR values taking 10.8% as the cut-off point. Five-year disease-specific survival for patients with WLNR ≤ 10.8% (n = 89, 45.2%) was 39.9% (IC 95% 29.4–50.4%), and for patients with WLNR ≥ 10.8% (n = 108, 54.8%) it was 20.5% (IC 95% 12.3–28.7%) (p = 0.007). The multivariate analysis showed the WLNR had a significant prognostic capacity.


As a variable that integrates data related to the number of metastatic nodes with extracapsular spread to the LNR, the WLNR has a prognostic value in the pathological assessment of HNSCC patients with regional recurrence treated with salvage neck dissection.

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Grant from Plan Estatal de I + D + I del Instituto de Salud Carlos III: FIS PI19/01661 a XL (cofunded by the European Regional Development Fund (ERDF), A Way to Build Europe).

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Correspondence to Eduard David Neumann.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional, regional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Neumann, E.D., Sansa, A., Casasayas, M. et al. Prognostic capacity of the weighted lymph node ratio in head and neck squamous cell carcinoma patients treated with salvage neck dissection. Eur Arch Otorhinolaryngol (2021).

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  • Lymph node ratio
  • Extracapsular spread
  • Prognostic capacity
  • Salvage neck dissection