Prognostic value of lymph node ratio and log odds of positive lymph nodes in oral cavity squamous cell carcinoma: a single-center retrospective study

Objectives: This study aimed to evaluate whether the lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS) provide superior prognostic stratification compared with the N-classification in oral cavity squamous cell carcinoma (OSCC), particularly for identifying high-risk patients. Materials and methods: We retrospectively analyzed 879 OSCC patients treated with surgery and neck dissection. Optimal cut-offs for LNR and LODDS were determined using receiver operating characteristic analysis. Univariable and multivariable Cox models were built to assess the prognostic performance of lymph node metrics. Risk stratification was evaluated within American Joint Committee on Cancer and N-stage subgroups. Results: The cohort’s 5-year overall survival was 70.6%. Both LNR (>4.8%) and LODDS (>−1.04) were strong independent prognostic factors in multivariable analysis (both, P < 0.0001). The LNR-based model demonstrated a concordance index of 0.72, equivalent to the N-classification model. Crucially, both the LNR and LODDS models successfully stratified survival within conventional stage categories, including N0 patients. Conclusion: LNR provides prognostic discrimination comparable to that of the N-classification while offering enhanced risk stratification, especially in node-negative patients. LODDS offers similar advantages. Integrating these metrics could improve the identification of high-risk patients for treatment intensification.