Cervical lymph node metastasis in oral squamous cell carcinoma: From metastatic patterns and risk factors to the development and validation of a predictive model

Abstract

Cervical lymph node metastasis (CLNM) is the most critical prognostic factor in oral squamous cell carcinoma (OSCC). To facilitate individualized risk assessment, this study aimed to develop and internally validate a novel prediction model. We retrospectively analyzed 3723 patients with OSCC from a single center (2012–2023), with 2792 eligible patients randomly allocated to a training (n = 1954) and a validation set (n = 838). A rigorous variable selection process was employed, where predictors significant in univariable analysis were entered into a multivariable logistic regression model that utilized a stepwise forward and backward elimination procedure to identify the final set of predictors. Six factors were ultimately incorporated into the nomogram: clinical T stage, clinical N stage, histological grade, perineural invasion, time from onset to treatment, and alcohol consumption. The model demonstrated good discrimination in both training (AUC = 0.780) and validation (AUC = 0.744), excellent calibration, and clinical utility. In conclusion, this internally validated nomogram accurately predicts CLNM risk and can aid in tailoring neck management, pending external validation.