Background To analyze the prognostic value of the clinicopathological parameters of primary lesions for predicting cervical lymph node metastasis in patients with hypopharyngeal and/or supraglottic carcinoma. Methods We enrolled 127 patients with squamous cell carcinomas originating in the hypopharyngeal and/or supraglottic regions. Results Multivariate analysis identified the tumor depth as an independent predictive factor for lymph node metastasis (odds ratio, 4.959; 95% confidence interval, 2.290-10.739; P < 0.0001) with a predictive value of 0.966. A cutoff value of 4.5 mm was determined. Conclusion The tumor depth of the primary lesion is a potent predictor of cervical lymph node metastasis in hypopharyngeal and supraglottic carcinomas. In cases with clinically negative nodal status, elective neck dissection should be adopted for patients with a tumor depth reaching 4.5 mm. Regular outpatient follow-up is recommended for patients with a tumor depth less than 1.0 mm. Close follow-up or preventative therapy should be considered between 1.0 and 4.5 mm.