Prognostic Models for Overall and Disease-Specific Survival in Palate Squamous Cell Carcinoma: Implications for Postoperative Radiotherapy.

Abstract

This study aimed to develop lymph node ratio (LNR)-integrated nomograms to predict overall survival (OS) and disease-specific survival (DSS) in palate squamous cell carcinoma (PSCC) and to guide postoperative radiotherapy (PORT) decisions. Data from PSCC patients were analyzed to identify prognostic factors, and nomograms were constructed. Performance was assessed using the area under the curve (AUC), calibration plots, and decision curve analysis. PORT benefits were evaluated across risk groups. Among 959 patients, 5-year OS and DSS were 47.0% and 60.9%, respectively. LNR > 6% was associated with significantly increased mortality. The nomograms showed favorable accuracy (OS 1/3/5-year AUC: 0.780/0.703/0.745; DSS 1/3/5-year AUC: 0.789/0.714/0.700), with calibration plots showing excellent agreement between predicted and observed survival. High-risk patients had significantly poorer survival outcomes than low-risk patients, with PORT benefiting only high-risk groups. The LNR-based nomograms improve prognostic prediction and optimize PORT selection, offering valuable guidance for personalized treatment.