Objectives Oral tongue cancer is the most prevalent type of oral cavity cancer and presents the worst prognosis. With the use of tumor, lymph node, distant metastasis (TNM) staging system, only the tumor and lymph node size are taken into account. However, several studies have considered the tumor volume as a possible significant prognostic factor of oral tongue cancer with cervical lymph node metastasis. Our study, therefore, aimed to explore the prognostic implications of the relevant nodal volume. Design, Setting and Participants Medical records and imaging (either from computed tomography scan, CT scan or magnetic resonance imaging scan, MRI scan) of 70 patients diagnosed with oral tongue cancer with cervical lymph node metastasis between January 2011 and December 2016 were retrospectively reviewed. Main outcome measures The nodal volume was measured from the imaging using the Eclipse application (Version 15.6.05, Varian company) and was further analyzed for its prognostic implications, particularly on overall survival, disease-free survival, and distant metastasis-free survival. Results From a receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of the nodal volume was 3.95 cm3, to predict the disease prognosis, in terms of overall survival and metastatic-free survival (p= <0.001 and p=0.005, respectively), but not the disease-free survival (p=0.241). For the multivariable analysis, the nodal volume, but not TNM staging, was a significant prognostic factor for distant metastasis (HR=4.5, 95%CI 1.1-17.94, p=0.036 vs p=0.459, respectively). Conclusions In patients with oral tongue cancer and cervical lymph node metastasis, the presence of a nodal volume of 3.95 cm3 was a poor prognostic factor for distant metastasis. Therefore, the lymph node volume from the current imaging protocol may be useful in adjunct with the current staging system to predict the disease prognosis