Age-based prognosis in oral tongue squamous cell carcinoma patients: A systematic review and meta-analysis

Abstract Background The prognostic significance of younger age in oral tongue squamous cell carcinoma (OTSCC) remains uncertain because age definitions, treatment strategies, outcome definitions, and adjustment methods vary substantially across studies. Objective To evaluate the prognostic significance of younger age in OTSCC by separately synthesising adjusted survival outcomes and event-based recurrence outcomes. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. Fifty studies were retained after detailed original-paper eligibility assessment. Random-effects models using restricted maximum-likelihood estimation and Hartung-Knapp confidence intervals were used for adjusted survival and recurrence syntheses. Nodal outcomes were synthesised narratively because endpoint definitions were not sufficiently comparable. Results Fourteen studies contributed to the main quantitative meta-analyses. Younger patients had improved adjusted overall survival (aHR 0.59, 95% CI 0.54–0.64; I²=0%), while adjusted disease-specific/cancer-specific survival (aHR 0.89, 95% CI 0.58–1.36; I²=0%) and disease-free/progression-free survival (aHR 0.71, 95% CI 0.22–2.30; I²=0%) did not differ significantly. Overall recurrence was higher in younger patients (RR 1.52, 95% CI 1.22–1.88; I²=0%). Local recurrence showed an elevated but non-significant pooled estimate (RR 1.61, 95% CI 0.85–3.07; I²=65.4%). Sensitivity analyses were directionally consistent, although several surgery-first estimates were imprecise. Conclusions Younger age alone does not appear to be an independent adverse prognostic factor for survival in OTSCC. The higher overall recurrence risk warrants attention, but the heterogeneous local recurrence evidence and unadjusted event-based analyses require cautious interpretation. Treatment should remain guided primarily by tumour stage and pathological risk factors rather than chronological age alone.