Diagnostic Efficacy of Clinico-Pathological Parameters in Predicting Nodal Positivity in Oral Cavity Squamous Cell Carcinoma: A Multivariate Risk Assessment

Background and Objectives: This study investigated clinicopathological factors associated with occult cervical lymph node metastasis in clinically node-negative oral cavity squamous cell carcinoma (OCSCC). Materials and Methods: This retrospective study included 108 patients who underwent primary tumor resection and elective neck dissection. Depth of invasion (DOI), lymphovascular invasion (LVI), perineural invasion, and histological grade were evaluated. Receiver operating characteristic analysis and multivariable logistic regression were used to assess associations with pathological nodal positivity. Results: Occult nodal metastasis was identified in 27 patients (25%). The cohort-derived DOI threshold was 8.5 mm, with an area under the curve of 0.841. LVI and histological grade were associated with nodal positivity in the multivariable analysis, although the adjusted estimates were imprecise. Conclusions: Histopathological characteristics were associated with occult nodal metastasis in this selected surgical cohort. However, the limited number of nodal events and the postoperative availability of key variables restrict clinical applicability. These exploratory findings require independent validation and should not be used to determine whether elective neck dissection can be omitted.