Survival Outcomes and Prognostic Determinants in 2,983 Patients with Primary Oral Squamous Cell Carcinoma: An 11-Year Retrospective Cohort Study.

OBJECTIVE: This study aimed to evaluate overall survival (OS), identify independent prognostic factors, and characterize prognostic heterogeneity across clinical subgroups in a large single-center Chinese cohort of patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: We retrospectively reviewed 2,983 primary OSCC patients undergoing radical surgery between June 2012 and December 2023. OS was analyzed using Kaplan-Meier methods and Cox proportional hazards models. Subgroup analyses were performed according to gender, age, and anatomical site. RESULTS: The 1-, 3-, and 5-year OS rates were 92.0%, 79.6%, and 74.4%, respectively. Multivariate analysis identified age, alcohol consumption, time to presentation (TTP), perineural invasion (PNI), histological grade, pathologic tumor stage (pT stage), and pathologic lymph node stage (pN stage) as independent prognostic factors. Among these, pN stage showed the strongest association with survival, with a stepwise increase in risk from N1 (HR 1.60, 95% CI 1.31-1.96) to N2 (HR 2.34, 95% CI 1.97-2.78; both P<0.001). Although the prognostic determinants varied across subgroups, pN stage remained a consistent independent predictor across nearly all subgroups defined by gender, age, and anatomical site. CONCLUSIONS: In this large Chinese OSCC cohort, pN stage was the most robust and consistent prognostic determinant across clinical subgroups, underscoring its central role in risk stratification and supporting more individualized prognostic assessment.