Effective Predictor Factors for Lymph Node Metastasis and Survival in Patients with Betel Nut-Related Oral Squamous Cell Carcinoma

<b>Background:</b> The Ministry of Health and Welfare has reported oral cancer to be one of the most prevalent malignant cancers; it has the third highest incidence rate of all cancers and is the fifth leading cause of death among men in Taiwan. Lymph node metastasis in oral cancer usually has a low survival rate, with no significant improvement in the past 30 years. Therefore, a more effective survival predictor is warranted. Many cancer studies have revealed that monitoring tumor thickness and lymph node density, in addition to tumor, node, and metastasis (TNM) stages, can provide more accurate predictions. <b>Methods:</b> This retrospective study analyzed data from 612 patients with oral cancer who had the habit of chewing betel nuts. The study focused on tumor thickness, lymph node density, and the regional distribution of lymph node metastasis to determine their effectiveness as predictors. <b>Results:</b> The results revealed that a tumor thickness of 6 mm indicated cervical lymph node metastasis and was the optimal cutoff point for overall survival. The optimal cutoff value for lymph node density was 0.04. Patients with a tumor thickness of >6 mm and a lymph node density of >0.04 had significantly lower overall survival rates. Additionally, patients with >1 lymph node metastasis level and lower cervical metastasis exhibited a relatively worse prognosis. <b>Conclusions:</b> Therefore, in addition to TNM staging, tumor thickness, lymph node density, and metastasis level are suitable as parameters for predictors that can be used as references for adjuvant therapies for better therapeutic effects.