The impact of patient age on the oncological prognosis of oral squamous cell carcinoma

Epidemiological data show that while age-standardized mortality rates of oral squamous cell carcinoma (OSCC) have slightly declined, the absolute number of deaths continues to rise, with a concerning increase among younger patients and persistently high mortality in the elderly. The aim of this study was to assess the influence of age on oncological prognosis and to classify it within a multivariable model alongside established histopathological risk factors. In this retrospective single-center study, patients surgically treated for OSCC between 2012 and 2023 were included according to predefined eligibility criteria and stratified into three age groups (< 50, 50–69, ≥ 70 years). Primary endpoints were overall survival (OS) and disease-free survival (DFS). Prognostic factors were further evaluated with multivariable Cox regression models and competing-risk analyses, with age assessed both as a categorical and continuous variable using restricted cubic splines. In 525 included patients (mean age 63.5 years), age distribution was multimodal with three peaks in concordance with the predefined groups. Local recurrence, distant metastasis, and secondary cervical lymph node metastasis (CLNM) were weakly correlated overall, with a stronger association between CLNM and distant metastasis in younger patients. Age significantly predicted overall survival (HR per 10 years: 1.56, 95% CI: 1.29–1.90), but showed no independent association with disease-free survival. Age presented with a multimodal distribution with distinct clinical patterns across the subgroups and was independently associated with worse OS. Nevertheless, no association was observed for DFS, suggesting that age-related differences in mortality may be influenced by non-oncologic factors. While correlations between recurrence events were generally weak, younger patients displayed a stronger link between regional and distant metastasis, emphasizing the importance of age-related follow-up.