Prognostic utility of monocyte to albumin ratio in patients undergoing resection for oral squamous cell carcinoma

Background To evaluate the prognostic significance of preoperative monocyte-to-albumin ratio (MAR) in patients with oral squamous cell carcinoma (OSCC). Methods This study enrolled 408 patients diagnosed with OSCC who underwent primary radical surgery between 2011 and 2017. Preoperative MAR was calculated as the ratio of absolute monocyte count (∗10 6 /L) to serum albumin level (g/L), measured within one week before surgery, while univariate and multivariate survival analyses were conducted using Kaplan-Meier and Cox proportional hazards regression models. A nomogram incorporating various clinicopathological factors was developed to predict overall survival (OS) on an individualized basis. Results The 5-year rates for OS, cancer-specific survival (CSS), and relapse-free survival (RFS) were 81.6%, 88.9% and 82.7% respectively. The optimal cut-off value for MAR was determined to be 8.31. Patients with high MAR values had significantly lower 5-year OS (75.1% vs. 91.3%, p < 0.001), CSS (83.5% vs. 96.9%, p < 0.001) and RFS (77.0% vs. 91.1%, p < 0.001) compared to those with low MAR values. In Cox regression analysis, high MAR independently predicted worse outcomes for OS (HR: 1.91, 95% CI: 1.1–3.317, p = 0.022), CSS (HR: 3.43, 95% CI: 1.329–8.852, p = 0.011) and RFS (HR: 2.282, 95% CI: 1.245–4.183, p = 0.008). The MAR-based nomogram demonstrated good predictive accuracy for OS (concordance index: 0.751). Conclusion The preoperative MAR is a valuable prognostic marker in OSCC. Integration of MAR into nomogram-based risk assessment models could enhance the stratification of patients at higher risk of adverse oncological outcomes, thereby informing treatment decisions.