A Novel Fibrosis-Integrated Nomogram for Predicting Survival in Oral Squamous Cell Carcinoma Patients with Oral Submucous Fibrosis - A Retrospective Cohort Study

Q: What is the main goal of the study?

To develop a fibrosis-integrated nomogram that predicts individualized survival for OSCC patients with coexisting oral submucous fibrosis, using prognostic factors not captured by conventional TNM staging.

Q: How was the nomogram developed and validated?

A retrospective cohort of 314 OSCC patients with OSF was split into training (n=220) and validation (n=94) sets. Cox regression identified independent prognostic factors, which were integrated into a nomogram for 1-, 3-, and 5-year overall survival, then evaluated with discrimination and calibration analyses.

Q: Which factors were identified as independent prognostic variables?

Maximum mouth opening, areca nut chewing duration over 20 years, N2-3 category, poor differentiation, perineural invasion, and positive surgical margin.

Q: How did the nomogram compare with TNM staging?

The fibrosis-integrated nomogram showed better discrimination than TNM staging, with higher C-indices in both training and validation sets, and risk stratification into three prognostic groups with distinct 5-year OS rates.

Sep 23, 2026

Uploaded by Aditya

Fibrosis-integrated nomogram development for individualized survival prediction in oral squamous cell carcinoma (OSCC) with oral submucous fibrosis (OSF) addresses prognostic gaps left by conventional TNM staging. A retrospective cohort study analyzed 314 OSCC patients with coexisting OSF treated from 2015 to 2022, randomly split into training and validation sets. Cox regression identified six prognostic factors incorporated into a nomogram predicting 1-, 3-, and 5-year overall survival. Performance was evaluated by C-index, time-dependent ROC, calibration, and decision curve analysis, showing significant discrimination and better outcomes than TNM staging.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Background

Methods

Results

Conclusion

Introduction

Nomograms and prognostic tools

Cancer Management and Research Open Access Full Text Article ORIGINAL RESEARCH A Novel Fibrosis-Integrated Nomogram for Predicting Survival in Oral Squamous Cell Carcinoma Patients with Oral Submucous Fibrosis: A Retrospective Cohort Study Ting Lei 1 , Hong Dong 2 1Department of Stomatology, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China; 2Department of Dental Endodontics, Guoyao Dongfeng Dental Hospital, Shiyan, Hubei, People’s Republic of China Correspondence: Hong Dong, Department of Dental Endodontics, Guoyao Dongfeng Dental Hospital, Shiyan, Hubei, People’s Republic of China, Email [kqyxyjx@163.com](kqyxyjx@163.com) | Background: Oral squamous cell carcinoma (OSCC) with oral submucous fibrosis (OSF) represents a distinct clinicopathological entity with unique prognostic factors not captured by conventional TNM staging. We aimed to develop a fibrosis-integrated nomogram (FIN) for individualized survival prediction in this population.
Methods: We conducted a retrospective cohort study of 314 consecutive OSCC patients with coexisting OSF treated between 2015 and 2022. Patients were randomly divided into training (n=220) and validation (n=94) sets. Independent prognostic factors were identified using Cox regression and integrated into a nomogram predicting 1-year, 3-year, and 5-year overall survival (OS) . Model performance was assessed using C-index, time-dependent ROC curves, calibration plots, and decision curve analysis.
Results: Six independent prognostic factors were identified: maximum mouth opening (HR 0.92, P<0.001), areca nut chewing duration >20 years (HR 1.78, P=0.002), N2-3 category (HR 1.89, P=0.001), poor differentiation (HR 1.56, P=0.018), perineural invasion (HR 1.67, P=0.007), and positive surgical margin (HR 2.03, P=0.001) . The FIN demonstrated excellent discrimination, with C-indices of 0.79 (95% CI 0.75–0.83) in the training set and 0.77 (95% CI 0.72–0.82) in the validation set, significantly outperforming TNM staging (C-indices 0.68 and 0.66, respectively; both P<0.01) . Risk stratification identified three prognostic groups with 5-year OS rates of 78.6%, 48.3%, and 18.9%(log-rank P<0.001) .
Conclusion: The fibrosis-integrated nomogram significantly improves survival prediction for OSCC patients with OSF by incorporating simple clinical measures of fibrosis severity and carcinogen exposure, enabling individualized risk assessment.
Keywords: oral squamous cell carcinoma, oral submucous fibrosis, nomogram, survival prediction, areca nut chewing, maximum mouth opening, prognosis | | --- | | Introduction
Oral squamous cell carcinoma (OSCC) represents the most prevalent malignancy of the oral cavity, accounting for over 90% of oral cancers worldwide.1 Despite advances in surgical techniques, radiotherapy, and systemic therapy, the 5-year survival rate for OSCC remains approximately 50–60%, with limited improvement observed over the past decades.2 Notably, a substantial proportion of OSCC cases in specific geographic regions, particularly South and Southeast Asia, arise from oral submucous fibrosis (OSF), a chronic progressive fibrotic disorder of the oral mucosa strongly associated with areca nut chewing.3,4 OSF is recognized by the World Health Organization as a potentially malignant disorder, with malignant transformation rates ranging from 4% to 7% .5 The coexistence of OSF and OSCC creates a distinct clinicopathological entity characterized by unique biological behavior and prognostic implications that are not adequately captured by conventional staging systems.6
The tumor-node-metastasis (TNM) staging system, currently in its eighth edition, serves as the cornerstone for prognostication and treatment planning in head and neck oncology.7 However, the TNM system relies exclusively on anatomic extent of disease and fails to incorporate host-related factors, tumor microenvironment characteristics, or | [https://doi.org/10.2147/CMAR.S605497](https://

FAQs

What is the main goal of the study?

To develop a fibrosis-integrated nomogram that predicts individualized survival for OSCC patients with coexisting oral submucous fibrosis, using prognostic factors not captured by conventional TNM staging.

How was the nomogram developed and validated?

A retrospective cohort of 314 OSCC patients with OSF was split into training (n=220) and validation (n=94) sets. Cox regression identified independent prognostic factors, which were integrated into a nomogram for 1-, 3-, and 5-year overall survival, then evaluated with discrimination and calibration analyses.

Which factors were identified as independent prognostic variables?

Maximum mouth opening, areca nut chewing duration over 20 years, N2-3 category, poor differentiation, perineural invasion, and positive surgical margin.

How did the nomogram compare with TNM staging?

The fibrosis-integrated nomogram showed better discrimination than TNM staging, with higher C-indices in both training and validation sets, and risk stratification into three prognostic groups with distinct 5-year OS rates.

Sep 23, 2026

Uploaded by Aditya