Systemic Inflammatory Ratios Predict Survival in Oral Squamous Cell Carcinoma

OBJECTIVES: To investigate the prognostic value of the systemic inflammation-related biomarkers of neutrophil-lymphocyte, albumin-globulin, lymphocyte-monocyte, and platelet-lymphocyte ratios at three perioperative time points, and to explore their association with clinicopathologic features and disease-specific survival. METHODS: In 220 oral squamous cell carcinoma patients undergoing surgery (2012-2023), we assessed risk factors, such as extranodal extension, TNM stage, and biomarker cutoffs (neutrophil-lymphocyte 5.0; albumin-globulin 1.21; lymphocyte-monocyte 3.14; platelet-lymphocyte 218.9). Disease-specific survival was analyzed using Kaplan-Meier curves, log-rank tests, and Cox multivariate models. Significance set at p < 0.05. RESULTS: Biomarkers measured 3 months postoperatively were the strongest predictors. Multivariate analysis identified high neutrophil-lymphocyte (HR = 2.99, 95% CI 1.44-6.21; p = 0.003), low albumin-globulin (HR = 0.44, 95% CI 0.21-0.89; p = 0.023) ratios, and extranodal extension (HR = 3.17, 95% CI 1.54-6.52; p = 0.002) as independent predictors of poorer disease-specific survival. Importantly, neutrophil-lymphocyte prognostic impact was comparable to that of extranodal extension, a well-established pathological risk factor. CONCLUSIONS: Three months post-surgery, high neutrophil-lymphocyte and low albumin-globulin ratios independently predict worse disease-specific survival in oral cancer. Neutrophil-lymphocyte, a simple and widely available biomarker, offers prognostic insight comparable to extranodal extension, supporting its integration into postoperative risk stratification and potentially guiding adjuvant therapy decisions.