The level of lymph node metastases (LNM) may be an independent prognostic factor in patients with locally advanced head and neck squamous cell carcinoma (HNSCC), according to a recent study published online ahead of print in Cancer.1

These findings may add to the prognostic value of the American Joint Committee on Cancer (AJCC) T and N classification in these patients.

Researchers led by Yan Xing, MD, PhD, of Harvard Medical School in Cambridge, MA, looked through the Surveillance, Epidemiology, and End Results program (SEER) registry and identified oral cavity, oropharynx, larynx, and hypopharynx HNSCC in 14 499 patients.

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They used a multivariate Cox proportional hazards model in order to evaluate whether level of LNM was an independent prognostic factor.

The researchers found that both the AJCC N classification as well as the level of LNM demonstrated significant effects on overall survival in all of the observed subtypes of HNSCC except hypopharynx.

Among patients with N2 disease, AJCC classification was found to be significantly associated with overall survival in oropharynx and larynx HNSCC but not with the overall survival in oral cavity or hypopharynx HNSCC. Level of LNM was significantly associated with overall survival in patients with oral cavity, oropharynx, and larynx HNSCC, but not hypopharynx HNSCC.

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“With recursive-partitioning analysis, a simple, primary site-specific prognostic tool integrating the AJCC T and N classifications and the level of LNM was designed, and it could be easily used by health care providers in clinic,” the authors noted.


  1. Xing Y, Zhang J, Lin H, et al. Relation between the level of lymph node metastasis and survival in locally advanced head and neck squamous cell carcinoma [published online ahead of print November 10, 2015]. Cancer. doi: 10.1002/cncr.29780.