A disease-specific immunonutritional model for prognostic stratification in oral cavity squamous cell carcinoma

The Naples Prognostic Score (NPS) has demonstrated prognostic value across malignancies; however, its applicability to oral cavity squamous cell carcinoma (OCSCC) remains uncertain. We aimed to develop a disease-specific immunonutritional model for prognostic stratification in surgically treated OCSCC, informed by the NPS framework.

We retrospectively analyzed 351 patients undergoing curative surgery for OCSCC (2009-2018). Survival-optimized cutoffs for albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio were determined using X-tile and integrated into a composite score (OCSCC-specific Naples Prognostic Score, OCNPS) to classify patients into three risk groups (Groups 0-2). Associations with overall survival (OS) and disease-free survival (DFS) were evaluated using Cox proportional hazards models.

The proposed model stratified patients into distinct risk groups and was associated with adverse pathological features. Five-year OS rates were 81.2%, 63.4%, and 10.4% across Groups 0-2, whereas the original NPS did not discriminate between low- and intermediate-risk patients. In multivariable analyses, higher OCNPS categories independently predicted worse OS and DFS (Group 1: HR 1.63 and 1.42; Group 2: HR 6.46 and 6.66). A nomogram incorporating OCNPS improved prognostic discrimination compared with TNM staging (C-index 0.769 vs. 0.652) with good calibration.

The OCNPS enables preoperative identification of patients with OCSCC at higher risk of adverse postoperative outcomes and provides clinically applicable prognostic information beyond conventional staging, supporting its potential role in OCSCC management.