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Prognostic Disparities in Multiple versus Single Primary OSCC: A Large-Cohort Analysis and Predictive Modelling

Qiang Xu¹, Bingju Gao², Xianglong Zheng²

¹Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Oral and Maxillofacial Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China; Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China.

International Dental Journal

|July 14, 2026

Summary

Patients with multiple primary oral squamous cell carcinoma (OSCC-MPCs) have distinct characteristics and poorer survival than those with single primary OSCC. New nomograms integrating clinical factors and neutrophil-to-lymphocyte ratio (NLR) aid in personalized treatment and surveillance.

Area of Science:

Oncology
Cancer Research
Head and Neck Cancers

Background:

Rising incidence of multiple primary cancers in oral squamous cell carcinoma (OSCC) patients poses clinical challenges.
Understanding distinct phenotypes and outcomes of OSCC with multiple primary cancers (OSCC-MPCs) versus single primary OSCC (SPOSCC) is crucial.

Purpose of the Study:

To characterize clinicopathological phenotypes and survival of OSCC-MPCs compared to SPOSCC.
To develop prognostic nomograms for OSCC-MPCs to predict overall survival (OS) and progression-free survival (PFS).

Main Methods:

Retrospective cohort study (2015-2025) analyzing clinicopathological data and systemic inflammatory indices.
Kaplan-Meier analysis for survival comparison; LASSO regression for predictor identification and nomogram construction.

Main Results:

OSCC-MPCs cohort: older, less smoking/alcohol, higher T/lower N stages, elevated preoperative neutrophil-to-lymphocyte ratio (NLR).
Significantly inferior 5-year OS (51.28% vs. 79.85%) and PFS (37.97% vs. 63.05%) in OSCC-MPCs vs. SPOSCC.
Independent predictors identified: age > 60, advanced T/N, NLR > 2.5, treatment modalities; nomograms showed reliable discrimination.

Conclusions:

OSCC-MPCs display unique phenotypes and significantly worse survival than SPOSCC.
Developed nomograms integrating clinicopathological features and NLR offer non-invasive tools for tailored therapy and surveillance.

Keywords:

Multiple primary cancers Neutrophil-to-lymphocyte ratio Nomogram Oral squamous cell carcinoma Risk stratification

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