Lymph Node Ratio and its Association with Histopathological Parameters in Oral Squamous Cell Carcinoma: A Cross-sectional Study

Abstract

Introduction: Oral Squamous Cell Carcinoma (OSCC) is one of the most common malignancies of the oral cavity and is associated with significant morbidity and mortality. Cervical lymph node metastasis is an important prognostic factor influencing disease outcome. The lymph node ratio (LNR), defined as the ratio of metastatic lymph nodes to the total number of lymph nodes examined, has emerged as a useful prognostic marker reflecting the extent of nodal metastatic burden and potentially providing additional prognostic information beyond conventional nodal staging. Aim: To assess the LNR in surgically treated cases of OSCC and evaluate its association with histopathological parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India, over a study period from November 2024 to September 2025. A total of ninetysix histopathologically confirmed cases of OSCC treated by primary surgical resection with neck dissection were included. Clinicopathological parameters, including age, sex, tumour site, tumour thickness, Depth of Invasion (DOI), Lymphovascular Invasion (LVI), Perineural Invasion (PNI), bone invasion, pathological T stage, N stage, TNM stage, nodal status, number of lymph nodes retrieved, number of metastatic lymph nodes, and LNR, were recorded. Using Chi-square test to determine the association between LNR and histopathological parameters. A p-value ≤0.05 of was considered statistically significant. Results: Among the ninety-six cases studied, the mean age was 56.65 years, with the majority of tumours arising in the buccal mucosa. Significant associations were observed between LNR and nodal status (p<0.001), pathological N stage (p<0.001), TNM stage (p<0.001) and tumour thickness (p=0.042). Age, sex, pathological T stage, DOI, LVI, PNI and bone invasion demonstrated no significant associations with LNR. Higher LNR values were associated with advanced disease and adverse histopathological features, indicating a greater risk of tumour progression. Conclusion: The present study demonstrates that LNR is significantly associated with important histopathological prognostic parameters in OSCC, particularly nodal status, pathological N stage, TNM stage, and tumour thickness. LNR may serve as a valuable adjunct prognostic marker for assessing nodal disease burden and may assist in risk stratification and therapeutic decision-making in patients with OSCC.