Preoperative inflammatory biomarkers as predictors of 5-year survival in oral cavity squamous cell carcinoma: Emphasis on the neutrophil-to-lymphocyte ratio.

Authors

R Gómez-Fernández, C García-Sierra, B Zarauza-Santos, J Piedras-Castro, J Vallejo-Díez, B Burgos-Vico, E Fernández-Fernández, L-M Redondo-González

Published in

Medicina oral, patologia oral y cirugia bucal. Volume 31. Issue 6. Pages e899-e907. Nov 01, 2026. Epub Nov 01, 2026.

Abstract

Prognostic stratification in oral cavity squamous cell carcinoma (OCSCC) remains challenging beyond the TNM system. Systemic inflammatory biomarkers obtained from routine preoperative blood tests have been proposed as low-cost prognostic adjuncts. This study aimed to evaluate the prognostic value of preoperative inflammatory biomarkers - particularly the neutrophil-to-lymphocyte ratio (NLR) - in predicting 5-year survival in a Western OCSCC cohort treated surgically.
Retrospective cohort study of 168 patients with histologically confirmed OCSCC treated with primary surgery between 2015 and 2022 at a tertiary referral centre. Preoperative NLR, platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) were analysed against the primary endpoint of 5-year overall survival. Multivariate logistic regression, ROC analysis with Youden index, Kaplan-Meier and Cox proportional hazards regression were performed. Disease-specific survival (DSS) was assessed as a sensitivity analysis.
At 5 years, 96 patients (57.1%) were alive and 72 (42.9%) had died. Patients who died had significantly higher NLR (median 3.14 vs 2.27; p < 0.001) and neutrophil counts (p = 0.002), and lower LMR (p = 0.008). In multivariate analysis adjusting for age, T stage and nodal status, NLR remained an independent predictor of mortality as a continuous variable (OR 1.34, 95% CI 1.04-1.73; p = 0.024) and when dichotomised at the ROC-derived cut-off of 3.06 (OR 2.55, 95% CI 1.22-5.33; p = 0.013). The area under the ROC curve was 0.674. PLR and LMR did not retain significance in the multivariate model. Kaplan-Meier analysis confirmed significantly worse survival in patients with NLR ≥ 3.06 (5-year survival: 37.1% vs 69.0%; log-rank p < 0.001). In a disease-specific survival sensitivity analysis, patients with NLR ≥ 3.06 also showed worse 5-year DSS (52.7% vs 75.9%; log-rank p = 0.002); this association was significant in univariate Cox analysis but was attenuated after adjustment for age and nodal status.
Preoperative NLR is an independent and clinically applicable predictor of 5-year survival in surgically treated OCSCC, outperforming other routinely available inflammatory biomarkers. Its integration into routine preoperative assessment may improve prognostic stratification at no additional cost.

PMID:
42960905
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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