Background/Objectives: This study aimed to evaluate the prognostic significance of lymph node density (LND) and the log odds of positive lymph nodes (LODDS) in patients with oral squamous cell carcinoma (OSCC) using a nationwide database. Methods: A retrospective cohort study was conducted using the Taiwan Cancer Registry to identify patients diagnosed with OSCC who underwent surgery for both the primary tumor and neck dissection. Clinicopathological variables were collected, and survival outcomes were analyzed using Cox proportional hazards models. LND was categorized as negative, <0.05, and ≥0.05; LODDS was grouped into four categories: <−4, −4 to −3.5, −3.5 to −2.5, and ≥−2.5. Results: A total of 1643 female and 15,475 male patients were included, with a mean age of 57.4 years (range, 20–98 years). In multivariable Cox regression analyses, LND and LODDS were identified as independent prognostic factors for overall survival. Compared with patients with negative LND, the hazard ratios for LND < 0.05 and LND ≥0.05 were 2.12 (95% CI, 1.90–2.36) and 3.35 (95% CI, 3.05–3.67), respectively (p< 0.01). Similarly, relative to the lowest LODDS group (<−4), the hazard ratios for the higher categories were 1.51 (95% CI, 1.32–1.74) for −4 to −3.5, 2.30 (95% CI, 2.05–2.57) for −3.5 to −2.5, and 4.32 (95% CI, 3.85–4.86) for ≥−2.5 (p< 0.01). Conclusions: LND and LODDS are significant prognostic indicators in OSCC. Incorporating these lymph node–based metrics into prognostic models may enhance risk stratification and inform clinical decision-making.
背景/目的：本研究旨在利用全国性数据库评估淋巴结密度（LND）与阳性淋巴结对数比（LODDS）对口腔鳞状细胞癌（OSCC）患者的预后意义。方法：通过台湾癌症登记数据库开展回顾性队列研究，纳入接受原发肿瘤切除及颈部淋巴结清扫术的OSCC确诊患者。收集临床病理学变量，并采用Cox比例风险模型分析生存结局。LND分为阴性、<0.05和≥0.05三组；LODDS分为<-4、-4至-3.5、-3.5至-2.5及≥-2.5四组。结果：共纳入1643例女性与15475例男性患者，平均年龄57.4岁（范围20-98岁）。多变量Cox回归分析显示，LND与LODDS均为总体生存期的独立预后因素。与LND阴性组相比，LND<0.05组与LND≥0.05组的风险比分别为2.12（95% CI 1.90-2.36）和3.35（95% CI 3.05-3.67）（p<0.01）。相较于最低LODDS组（<-4），较高分组的风险比依次为：-4至-3.5组1.51（95% CI 1.32-1.74）、-3.5至-2.5组2.30（95% CI 2.05-2.57）、≥-2.5组4.32（95% CI 3.85-4.86）（p<0.01）。结论：LND与LODDS是OSCC重要的预后指标，将这两项基于淋巴结的指标纳入预后模型可优化风险分层，为临床决策提供依据。
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