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. 2025 Feb 20;25(1):268.
doi: 10.1186/s12903-025-05663-6.

Development of a predictive nomogram based on preoperative inflammation-nutrition-related markers for prognosis in locally advanced lip squamous cell carcinoma after surgical treatment

Hao Cheng  1   2 , Xue-Lian Xu  3 , Zheng Zhang  1 , Jin-Hong Xu  4 , Zhuo-Ran Li  5 , Ya-Nan Wang  5 , Bo-Dong Zhang  6 , Ke Chen  1 , Shou-Yu Wang  1
Affiliations

Development of a predictive nomogram based on preoperative inflammation-nutrition-related markers for prognosis in locally advanced lip squamous cell carcinoma after surgical treatment

Hao Cheng et al. BMC Oral Health. .

Abstract

Background: The prognostic role of preoperative inflammation-nutrition-related markers in locally advanced lip squamous cell carcinoma (LSCC) remains underexplored. This study aimed to assess the impact of various preoperative inflammation-nutrition-related markers on the prognosis of patients with locally advanced LSCC undergoing surgical treatment and to establish a corresponding predictive model.

Methods: A retrospective analysis was performed on the clinical data of 169 patients with locally advanced LSCC who underwent surgical treatment. A total of 27 clinicopathological variables, including inflammation-nutrition-related markers, were collected. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors for disease-free survival (DFS) and overall survival (OS). The nomogram models were validated using receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). Risk stratification was performed based on the nomogram scores, and differences between risk subgroups were explored.

Results: The extranodal extension (ENE), surgical safety margin, Glasgow prognostic score (GPS), Geriatric Nutritional Risk Index (GNRI), Controlling Nutrition score (CONUT), American Joint Committee on Cancer (AJCC) stage, and adjuvant radiotherapy were independent prognostic factors for DFS. In contrast, ENE, surgical safety margin, GNRI, CONUT, AJCC stage, and adjuvant radiotherapy were also independent prognostic factors for OS. The nomograms demonstrated better predictive performance than the AJCC staging system. Based on the nomogram model, patients were stratified into low-, medium-, and high-risk subgroups, which exhibited significant differences in survival outcomes.

Conclusion: GPS, GNRI, and CONUT are independent factors affecting the prognosis of patients with locally advanced LSCC undergoing radical surgery. By combining GPS, GNRI, and COUNT with other independent clinicopathological prognostic factors, a reliable nomogram model can be established to accurately predict patients' DFS and OS. This provides a powerful tool for individualized prognostic assessment, optimized risk stratification, and treatment decision-making.

Keywords: Controlling nutrition score; Geriatric nutritional risk index; Inflammation-nutrition-related markers; Lip squamous cell carcinoma; Prognosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study adhered to the principles outlined in the Declaration of Helsinki. Ethics approval was obtained from the Ethics Committee of the First Affiliated Hospital of Xinxiang Medical University, and the clinical trial number was EC-024–496. Written informed consent was provided by all patients. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart for the study. ECOG, eastern cooperative oncology group; PS, performance status
Fig. 2
Fig. 2
Prognostic nomograms for DFS (A) and OS (B) in locally advanced LSCC patients post-surgery: a case illustration using new predictive models. This figure demonstrates a patient-specific example utilizing novel models to predict DFS and OS. The size of each rectangle reflects the number of cases corresponding to different prognostic scenarios. AJCC, American Joint Committee on Cancer; COUNT, controlling nutrition scores; DFS, disease-free survival; ENE, extranodal extension; GPS, Glasgow prognostic score; GNRI, Geriatric Nutritional Risk Index; LSCC, lip squamous cell cancer; OS, overall survival
Fig. 3
Fig. 3
Time-dependent ROC curves. AUC for predicting 3-, and 5-year DFS in the training (A) and validation (B) set; ROC curves corresponding to 3-, and 5-year OS in the training (C) and validation (D) cohort. AUC, area under curve; OS, overall survival; DFS, disease-free survival; ROC, receiver operating characteristic
Fig. 4
Fig. 4
Calibration plots for 3- and 5-year DFS and OS in postoperative locally advanced LSCC patients. This figure presents calibration plots for 3- and 5-year DFS in the training cohort (A, C) and validation cohort (B, D), along with OS in the training cohort (E, G) and validation cohort (F, H). The X-axis indicates model-predicted survival, while the Y-axis shows actual survival outcomes. The bar line represents the 95% CI based on Kaplan–Meier analysis, with the diagonal line serving as the ideal reference. OS, overall survival; CI, confidence interval; DFS, disease-free survival; LSCC, lip squamous cell cancer
Fig. 5
Fig. 5
DCA curves comparing nomograms and AJCC staging for DFS and OS. This figure shows DCA curves for 3- and 5-year DFS in the training set (A, C) and validation set (B, D), as well as 3- and 5-year OS in the training set (E, G) and validation set (F, H). AJCC, American Joint Committee on Cancer; DCA, decision curve analysis; DFS, disease-free survival; OS, overall survival
Fig. 6
Fig. 6
Kaplan–Meier curves for locally advanced LSCC patients post-surgery in training and validation cohort according to the new risk stratification system. Kaplan–Meier curves based on new risk stratification system for predicting DFS (A, C) and OS (B, D) in training and validation set, respectively. The red, green, and blue curves represent low-, medium-, and high-risk groups, respectively. DFS, disease-free survival; LSCC, lip squamous cell cancer; OS, overall survival
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