Overall survival of oral cancer from the population-based cancer registries of the Konkan area, Maharashtra, India

Oral cancer (C03-C06) is a major public health challenge in India, particularly in rural regions where tobacco consumption is widespread. Despite the high burden, literature on survival data from rural populations is scarce. This study aims to assess overall survival and to identify prognostic factors associated with survival of oral cancer (OC) patients, using data from rural Population-Based Cancer Registries (PBCRs) in the Konkan area of Maharashtra, India. This study was conducted on OC cases registered in the Ratnagiri and Sindhudurg PBCRs from 2017 to 2019. Survival was calculated from the date of diagnosis, with follow-up until December 31, 2023, or the date of death. Observed survival (OS) was calculated using the Kaplan-Meier method, and relative survival (RS) was calculated using the Pohar Perme method. Sociodemographic and treatment-related prognostic factors were assessed using the Cox proportional hazards model. Of the 656 OC patients, 245 patients (37.3%) were alive, while 411 (62.7%) had died by the end of follow-up period. The 5-year age-standardized relative survival (ASRS) for all ages was 38.01%. In multivariate analysis, no statistically significant differences in survival were observed across socio-demographic variables except income. Patients in the high-income group had better survival compared with those in the lower-income groups (HR: 0.56; 95% CI: 0.35–0.88). The highest 5-year survival was observed among patients treated with surgery combined with radiotherapy (57.75%), followed by surgery alone (55.57%). In contrast, patients treated with chemotherapy alone had poor survival (10.37%), reflecting presentation at advanced stages or management with palliative intent. Patients who completed the prescribed treatment protocol had significantly better survival compared with those who received no treatment after diagnosis (HR: 5.74; 95% CI: 4.09–8.07) and those who did not complete the prescribed treatment protocol (HR: 2.54; 95% CI: 1.83–3.51). Oral cancer survival in Konkan area is lower than that reported in urban regions, owing to socioeconomic disadvantage, late diagnosis, and low treatment uptake. Strengthening early detection, ensuring timely access to care, and raising awareness about tobacco cessation services and government health schemes can improve survival.