BACKGROUND: Lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), and the number of postoperative lymph node staging (pN) are prognostic indicators of various cancers. However, the prognostic values of these indicators remain unclear in hypopharyngeal squamous cell carcinoma (HPSCC). This study's primary objective was to investigate the predictive value of LNR, LODDS, and pN for advanced HPSCC, and the secondary objective was to compare which of the values had the best predictive value for advanced HPSCC. METHODS: A retrospective study was conducted on 166 patients with stage Ⅲ-Ⅳ HPSCC. LNR and LODDS were divided into two groups according to the defined cut-off values. Univariate and multivariate analyses on the risk of overall survival (OS) and progression-free survival (PFS) were performed, respectively. The predictive value of LNR was compared with that of LODDS and pN using receiver operating characteristic (ROC) curves. RESULTS: According to the X-tile, the cut-off values are 0.11 for LNR and -0.91 for LODDS. LNR, LODDS, and pN were significantly correlated with PFS by univariate analysis (p <
0.05). Multivariate analysis demonstrated that LNR was an independent prognostic factor for PFS (p <
0.01). Multivariate analysis also revealed that postoperative tumor staging (pT) classification (p = 0.003), LNR (p = 0.029), and surgical margins (p = 0.001) were independent prognostic factors for OS. LNR was demonstrated as an independent prognostic factor for PFS, other than LODDS and pN. CONCLUSION: LNR was an independent predictor for OS and PFS for advanced HPSCC.