Prognostic factors influencing overall and cancer-specific survival in elderly patients with oral and maxillofacial squamous cell carcinoma

Abstract

Abstract Background Oral and maxillofacial squamous cell carcinoma (OMSCC) is prevalent in the elderly, yet comprehensive prognostic analyses integrating host-related factors for this population are scarce. This study aimed to identify prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in elderly OMSCC patients, with a focus on the neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI). Materials and methods This retrospective study evaluated clinicopathological and laboratory data from 260 elderly patients with OMSCC between 2023 and 2025. (NLR, PNI). Cox regression analysis identified several independent prognostic factors for OS and CSS. A nomogram for CSS was developed and validated using C-index and calibration curves. Results Multivariable analysis identified T3-T4 stage (HR = 2.10, 95%CI 1.40–3.15), N+ stage (HR = 1.88, 95%CI 1.24–2.85), non-surgical treatment (HR = 2.38, 95%CI 1.55–3.65), NLR ≥ 3.5 (HR = 1.75, 95% CI 1.18–2.60), and PNI < 45 (HR = 1.98, 95% CI 1.34–2.92) as independent predictors of OS (all P < 0.01), with similar results for CSS. A combined prognostic effect was observed: patients with both high NLR and low PNI had the highest mortality risk (HR = 4.05, 95% CI 2.48–6.62). Formal interaction testing confirmed a statistically significant multiplicative interaction (HR for interaction = 1.89, 95% CI 1.21–2.95, P = 0.005), supporting a potential synergistic relationship. The nomogram for CSS showed good discrimination (C-index for 1-year: 0.77; 3-year: 0.74) and calibration, outperforming the traditional AJCC staging system. Conclusions Pretreatment NLR and PNI are independent prognostic factors in elderly OMSCC, with evidence of a potential synergistic interaction between them. A nomogram integrating these factors provides effective risk stratification, offering valuable guidance for personalized clinical decision-making in this vulnerable population.