Number and ratio of positive lymph nodes predict survival in pediatric salivary gland cancer

Pediatric salivary gland cancer (SGC) is a rare occurrence, prompting our aim to scrutinize the prognostic implications of diverse neck evaluation methodologies. Pediatric patients diagnosed with SGC were retrospectively identified from the SEER database. The evaluation of lymph node (LN) status encompassed the 8^th AJCC neck staging system, in addition to analyzing the quantity and proportion of metastatic LNs. Prognostic impacts were assessed utilizing Cox proportional hazards models. The study cohort comprised 274 patients, with 41 exhibiting LN metastasis. Neck stage distribution revealed N1 in 23 patients (8.4%), N2 in 14 patients (5.1%), and N3 in 4 patients (1.5%). Notably, 17 cases (6.2%) manifested two or more metastatic LNs. The median ratio of positive to total LNs was calculated at 0.1212. In comparison to N0 stage classification, a significantly elevated risk of mortality was associated with N2 stage rather than N1 or N3 distinctions. Patients with one positive LN paralleled those devoid of LN metastasis in terms of survival outcomes. Conversely, the presence of two or more metastatic LNs markedly correlated with an inferior prognosis. Individuals with a ratio exceeding 0.1212 demonstrated an almost twofold higher risk of mortality relative to those with a ratio of ≤ 0.1212. The assessment of the number and ratio of positive LNs, as opposed to the traditional AJCC neck stage categorization, yields a more refined stratification of survival outcomes in pediatric SGC.