Lymph Node Yield/Ratio, Neutrophil-Lymphocyte Ratio: Prognostic Factors in cN0 Laryngeal Carcinoma.

Objectives: The aim of this study was to investigate the role of lymph node yield (LNY), lymph node ratio (LNR), and neutrophil to lymphocyte ratio (NLR) as prognostic factors, their impact on survival in patients with advanced laryngeal squamous cell carcinoma (LSCC).

Methods: This multicentric retrospective study included 195 patients with clinical N0 advanced laryngeal carcinoma who underwent total laryngectomy and/or total pharyngolaryngectomy over 5 years. The number of lymph nodes extracted (LNY) and the number of positive nodes were counted. The lymph node ratio "LNR" was calculated as follows: (positive nodes /LNY). Moreover, neutrophil to lymphocyte ratio (NLR) was calculated and documented for analysis.

Results: The mean 5-years DFS and overall survival (OS) was 33 and 35 months. The following were statistically significant factors negatively associated with overall survival; LNR (p = 0.047), NLR > 7 (p = 0.05), preoperative tracheostomy (p = 0.016), infiltrated safety margin (p = 0.01), postoperative radiotherapy (p < 0.001), N stage (p = 0.019), and unilateral neck dissection (p = 0.03). On the other hand, DFS was negatively associated with LNR (p = 0.001), N stage (p = 0.001), and infiltration of the surgical margins (p = 0.001).

Conclusion: LNY and LNR are both linked to survival outcomes following neck dissection in patients with clinical N0, locally advanced laryngeal carcinoma, where higher LNY and lower LNR correlated with improved survival and could be easily incorporated into cancer staging systems to aid in the prognostic stratification of patients. Additionally, NLR could act as a cost-effective inflammatory biomarker predicting poor prognosis in LSCC.

Level Of Evidence: III Laryngoscope, 2025.