Sex Differences in Presentation, Management, and Prognosis of Surgically Treated Oral Tongue Carcinoma: A Retrospective Cohort Study

Abstract

AIM: Tongue carcinoma is an aggressive subtype of oral cavity cancer. Sex-related differences in disease presentation and prognosis remain incompletely understood.METHODS: This retrospective cohort study included patients with histologically confirmed oral tongue squamous cell carcinoma treated at Oncology Center Mansoura University (OCMU) in Egypt between 2007 and 2025. Baseline clinicopathological characteristics, recurrence, and overall survival were analyzed by sex. Survival was assessed using Kaplan–Meier analysis, log-rank testing, and Cox proportional hazards regression.RESULTS: Of 151 patients identified, 41 were excluded because of missing or indeterminate vital status, leaving 110 patients in the final analytic cohort (52 males and 58 females). Males had a significantly higher smoking prevalence than females (13/49 [26.5%] vs 2/55 [3.6%]; p = 0.001), but age, body mass index (BMI), T stage, nodal status, depth of invasion, histologic grade, and other adverse pathological features were broadly similar between sexes. Overall survival did not differ significantly by sex (log-rank p = 0.785). In univariate Cox analysis, advanced T stage, nodal positivity, and perineural invasion were associated with worse survival, but in a parsimonious multivariable model, only nodal positivity and advanced T stage remained significant.CONCLUSIONS: In this Egyptian cohort of oral tongue squamous cell carcinoma (SCC) patients, sex differences in presentation and outcome were minimal. Smoking exposure was substantially higher in men, but sex itself was not associated with survival after adjustment. Tumor burden, particularly nodal involvement and advanced T stage, was the main determinant of prognosis.