Perineural invasion, lactate dehydrogenase, globulin and serum sodium predicting occult metastasis in oral cancer.

OBJECTIVE This study aimed to develop a nomogram to predict the neck occult metastasis in early (T1-T2 cN0) oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS The nomogram was developed in a training cohort of 336 early OSCC patients and was validated in a validation cohort including 88 patients. Independent predictors were calculated by univariate and multivariate logistic regression analyses. RESULTS In univariate logistical regression analysis, gender, perineural invasion (PNI), blood vessel invasion, mean corpuscular hemoglobin, aspartate aminotransferase, prealbumin, globulin (GLO), lactate dehydrogenase (LDH), serum sodium (NA) and serum chloride were significant associated with neck occult metastasis. Multivariate logistical regression analysis identified PNI (P < 0.001), LDH (P = 0.003), GLO (P = 0.019) and NA (P = 0.020) as independent predictors of neck occult metastasis. Cut-off values for LDH, GLO and NA obtained from AUC were 142.5, 26.35 and 139.5 respectively. The nomogram based on PNI and categorical GLO, LDH and NA exhibited a strong discrimination, with a C-indexes of 0.748 (95%CI = 0.688 to 0.810) in the training cohort and 0.751 (95%CI = 0.639 to 0.863) in the validation cohort. CONCLUSIONS A nomogram based on PNI, LDH, GLO, and NA for predicting the risk of neck lymph nodes occult metastasis in OSCC could help surgeons with therapy decision-making.