Lymph node (LN) status is the single most important prognostic factor for squamous cell carcinoma of the oral cavity (OSCC). With an approximate 40 % incidence of lymphnode metastases (LNMs) in OSCC patients, one lymph node metastasis reduces global survival by approximately 50 % [1,2].

Despite significant advances in medical sciences [3,4] and related improvements in the prognosis for OSCC, [5] 33 % of patients develop nodal recurrences and the 5-year overall survival (OS) rate remains approximately 60 %. [1,6] Therefore effective neck management is essential for both oncological control and survival, as well as for accurate prognostication. The eighth edition of the Tumour-Node-Metastasis staging system (TNM 8th edition) of American Joint Committee on Cancer (AJCC) classification incorporated ENE into the pathological classification criteria, improving survival prediction compared to previous editions [7,8]. Standard pathological nodal staging (pN) considers the number, size, laterality, and extranodal extension (ENE) of positive lymph nodes [9]. However, some authors suggest that the AJCC pathological staging system doesn't consider the surgical technique used for neck dissection (ND), the extent of dissection, and the pathological scrutiny [10]. To further improve nodal disease definition, and to better manage postoperative therapies for pN + oral cancer, several authors have focused on alternative prognostic factors including the LN ratio (LNR, number of positive lymph nodes divided by the total number of lymph nodes excised, regardless of the extent of neck dissection), the number of positive LNs (PN) [1], and the LogODDS of positive LNs (log of the ratio between the number of positive lymph nodes + 0.5 and the number of negative lymph nodes + 0.5) [11].

Here, we aim to estimate the role of LogODDS as a prognostic factor in patients affected by oral cavity squamous cell carcinoma, in terms of overall survival (OS) and disease-free survival (DFS), looking for a cut-off value that allows to stratify them in high and low risk of recurrency, complementing existing systems and the other lymph node-related factors (LNR, pN in TNM VIII Ed.) and offering actionable insights for personalized treatment.