Number of positive nodes – Current relevance in determining prognosis of oral cavity cancer after the recent AJCC staging update

•Lymph node involvement is a significant prognosticator in oral cavity cancers.•In comparison with current AJCC staging, when increasing number of positive nodes are considered the survival statistics are better represented with regards to disease free survival.•This correlation is independent of extracapsular extension.•Number of positive nodes should be considered in staging of oral cavity cancers. Lymph node involvement and the number of positive nodes is a significant prognosticator in oral cavity cancers and current staging system does not incorporate it as an integral part. This was a retrospective study of oral cavity cancer patients who were operated during the time period of 2009–2017. The data was collected and analysed to assess the impact of increase in the number of positive nodes on survival and its comparison of survival statistics to current AJCC staging. A total of 1431 patients were included in this study and 32.5% of these patients had a node positive disease. Nodal positivity was a significant prognosticator on multivariate analysis. Number of positive nodes was modelled with restricted cubic spline function and it showed progressive worsening of survival functions with increase in number. On Kaplan Meier analysis there was a better separation of curves when number of positive nodes was used and Akaike information criterion (AIC) showed that it was a better prognosticator than existing AJCC staging. Number of positive nodes is a significant prognosticator of prognosis and hence should be considered in the AJCC staging system.