Comparison of Oral Squamous Cell Carcinoma With and Without Oral Submucous Fibrosis: Emphasis on Metastatic Potential and Survival Rate

ABSTRACT Objective Oral submucous fibrosis is a chronic oral disease with malignant potential. This study assessed survival outcomes and cervical lymph node metastasis in patients with oral squamous cell carcinoma arising from oral submucous fibrosis in central China. Methods 84 patients with carcinoma arising from oral submucous fibrosis treated between 2005 and 2019 were retrospectively reviewed and compared with 84 stage‐matched patients with oral squamous cell carcinoma unrelated to oral submucous fibrosis. Clinical features, recurrence, second primary tumors, lymph node metastasis, and survival were analyzed using chi‐square tests, Kaplan–Meier survival curves, Cox regression, and the Cochran–Mantel–Haenszel test. Results Patients with carcinoma arising from oral submucous fibrosis were more often male and had tumors predominantly located in the buccal mucosa. Compared with controls, these patients had significantly lower rates of cervical lymph node metastasis ( p < 0.001) but higher rates of local recurrence ( p = 0.012) and second primary tumors ( p < 0.001). Kaplan–Meier analysis demonstrated superior overall survival in the oral submucous fibrosis group ( p < 0.001). Multivariate Cox regression identified cervical lymph node metastasis ( p = 0.042), histological grade ( p = 0.038), local recurrence ( p < 0.001), and second primary tumors ( p = 0.012) as independent prognostic factors. The Cochran–Mantel–Haenszel test confirmed a tendency toward earlier nodal metastasis in oral submucous fibrosis‐related cases ( p < 0.001). Conclusions Carcinoma arising from oral submucous fibrosis demonstrates better survival outcomes and higher tumor differentiation but carries an increased risk of recurrence and second primary tumors. Enhanced clinical surveillance is recommended to improve early detection and patient prognosis.