Objective: To determine the prognostic value of lymph node density (LND) as a predictor for tumor recurrence in patients with advanced laryngeal carcinoma undergoing curative surgery.
Patients and methods: This is a prospective study, included 87 patients, diagnosed with locally advanced laryngeal carcinoma (T3 & T4a) and carried out total laryngectomy with neck dissection, presented to otorhinolaryngology outpatient clinic at faculty of medicine, Cairo university, Egypt, between June 2018 and May 2019. LND was determined by calculating the ratio between number of resected lymph nodes (LNs) positive for malignancy and total number of resected LNs. The mean follow up duration for tumor recurrence was 24 months (range 17 – 29 months).
Results: LND, number of positive LNs, involved surgical margins, presence of metastatic LNs and adjuvant chemoradiation were statistically significant predictors for disease recurrence in univariate analysis. LND was the only independent predictor of recurrence in pathologically positive neck node (pN+) patients in multivariate analysis. In patients with LND > 0.066, hazard ratio for disease recurrence was 3.887 (P=0.021), and for nodal recurrence was 6.453 (P=0.008), reaching LND > 0.25 significantly increased hazard ratio for recurrence to 5.838 (P=0.001), and for nodal recurrence to 9.329 (P=0.001) compared with pN0 cases.
Conclusion: LND was found to be the only independent predictor for disease recurrence in pN+ laryngeal cancer. LND should be used complementary to the conventional TNM staging to assess the precise risk of treatment failure and planning of possible postoperative adjuvant treatment.