Prognostic Value of Hematological Parameters in Oral Squamous Cell Carcinoma

SIMPLE SUMMARY: Oral squamous cell carcinoma is a challenging mouth cancer, with roughly half of those diagnosed succumbing to it, often due to it recurring or spreading to other body parts. Although some factors like tumor size, invasiveness, lymph node involvement, and specific characteristics when examining tissue samples are known to influence the disease’s severity, the role of blood-based parameters in predicting outcomes is less clear. In our research, we discovered that an easily measured blood parameter, known as RDW (red cell distribution width), exceeding 14.3%, can be just as effective as traditional factors in forecasting a patient’s risk of dying from this cancer. If a patient’s RDW is high, it is a signal for doctors to closely monitor and have more in-depth treatment discussions with the patient before initiating any therapies. This blood test offers a simple and accessible way to improve patient care and decision-making. ABSTRACT: Introduction: Oral squamous cell carcinoma (OSCC) remains a significant public health concern. The variables utilized to determine appropriate treatment for this disease also represent its most unfavorable prognostic factors, with these parameters solely determined by the neoplasm and its behavior. However, a lack of well-established indices is evident in the literature that specifically relate to the patient and indicate a worse prognosis. Objective: To assess the prognostic impact of hematological indices in patients with OSCC. Methods: This retrospective cohort study included patients with oral squamous cell carcinoma (OSCC) who underwent curative-intent treatment. Treatment encompassed surgery, followed by adjuvant therapy, as necessary. Laboratory tests were conducted immediately prior to surgery, and demographic information was obtained from medical records. Results: The cohort comprised 600 patients, with 73.5% being male subjects. Adjuvant treatment was recommended for 60.3% of patients. Throughout the follow-up period, 48.8% of participants died. Univariate analysis indicated that perineural invasion, angiolymphatic invasion, pT4 tumors, lymph node metastases, extranodal extravasation, RDW > 14.3%, NLR (neutrophil–lymphocyte ratio) > 3.38, PLR (platelet–lymphocyte ratio) > 167.3, and SII (systemic inflammatory/immune response index) > 416.1 were factors associated with increased mortality. These threshold values were established through ROC curve analysis. In the multivariate analysis, angiolymphatic invasion (HR = 1.43; 95% CI: 1.076–1.925; p = 0.014), pT4a/b tumors (HR = 1.761; 95% CI: 1.327–2.337; p < 0.001), extranodal extravasation (HR = 1.420; 95% CI: 1.047–1.926; p = 0.024), and RDW (HR = 1.541; 95% CI: 1.153–2.056; p = 0.003) were identified as independent risk factors for decreased overall survival. Conclusions: RDW > 14.3% was proven to be a reliable parameter for assessing overall survival in patients with OSCC. Further studies are required to evaluate the clinical applicability of other hematological indices.