Which is the most suitable lymph node predictor for overall survival after primary surgery of head and neck cancer: pN, the number or the ratio of positive lymph nodes, or log odds?

To investigate the best lymph node (LN) metastasis predictor for overall survival (OS) in head neck cancer (HNC): pN classification, number of positive lymph nodes (PNOD), lymph node ratio (LNR), or log odds of positive lymph nodes (LODDS). In total, 225 surgically treated HNC patients were evaluated for the different LN classifications and OS. Five-year OS was 71.8 %. Mean number of yielded LN and PNOD was 25.3 +/- A 16.7 and 2.7 +/- A 5.9, respectively. 64.8 % had a LNR > 0.10 and 64.4 % a LODDS > 10. In univariable analysis, multimodal therapy (p = 0.039), advanced pT (p < 0.0001), advanced UICC stage (p = 0.029), LNR > 0.10 (p = 0.049), and LODDS > -1.0 (p = 0.021) were associated with lower OS. In multivariable analysis, advanced pT [hazard ratio (HR) 2.194; 95 % confidence interval (CI) 1.294-3.722; p = 0.004] and LODDS > -1.0 (HR 1.634; 95 % CI 1.002-2.665; p = 0.059) remained independent predictors for lower OS. It seems useful to analyze the prognostic significance of LODDS in other samples of HNC.