Sex differences in prognosis of oral cavity carcinoma

To evaluate the impact of sex on survival outcomes in patients diagnosed with oral cavity squamous cell carcinoma in a region characterized by high exposure to toxic substances.

A retrospective analysis was conducted on 857 patients diagnosed and treated between 1985 and 2020. Survival outcomes were assessed based on sex, considering variables such as age, toxic substance exposure, tumor location, and type of treatment received.

Five-year CSS was significantly lower in women (52.3%, 95% CI: 3.2) compared with men (67.0%, 95% CI: 2.0; P=0.0001). No significant difference was found in 5-year OS between men (53.4%) and women (45.8%; P=0.238). In multivariable analysis, female sex remained an independent negative prognostic factor for CSS (HR 1.55, 95% CI: 1.14-2.10; P=0.005). Other variables associated with poorer CSS included age >80 years (HR 3.78, 95% CI: 2.38-5.82; P=0.0001), tongue tumor location (HR 3.10, 95% CI: 1.43-6.70; P=0.004), buccal mucosa tumors (HR 3.14, 95% CI: 1.35-7.32; P=0.008), and advanced stage (stage IV vs I: HR 8.93, 95% CI: 6.04-13.20; P=0.0001). Women showed a higher proportion of tumors in the tongue and upper gingiva/palate and were more frequently managed with palliative treatment.

Female patients exhibited significantly worse cancer-specific survival despite lower exposure to tobacco and alcohol. The persistently higher risk of cancer-related mortality among women after multivariable adjustment (HR 1.55) suggests underlying biological or hormonal differences influencing disease behavior. These findings highlight the importance of incorporating sex-specific prognostic considerations in the management of oral cavity carcinoma.