Wen, Ming-HsunMing-HsunWenChang, Dun-HaoDun-HaoChangHuang, Hsin-YiHsin-YiHuangYang, Wei-ChienWei-ChienYangHsu, Wan-LunWan-LunHsuCHUN-JU CHIANGWEN-CHUNG LEELiao, Li-JenLi-JenLiao2026-04-222026-04-222026-03https://scholars.lib.ntu.edu.tw/handle/123456789/737434Background: Staging of oral squamous cell carcinoma (OSCC) does not account for anatomical subsites. However, these subsites demonstrate considerable pathological heterogeneity and survival differences. Most prior studies have not systematically examined the influence of distinct pathological factors across subsites. Therefore, this study aimed to evaluate the clinical and pathological characteristics, as well as survival outcomes of OSCC across major oral subsites, using a nationwide cancer registry. Methods: A total of 17,118 patients with surgically treated OSCC diagnosed between 2018 and 2022 were identified from the Taiwan Cancer Registry. Pathological factors-including perineural invasion (PNI), lymphovascular invasion (LVI) and extranodal extension (ENE)-were analyzed across four major oral subsites (tongue, buccal mucosa, gum, and others). Multivariable logistic regression was used to assess the associations between pathological factors and subsites. Survival analyses were performed using life table methods with Kaplan-Meier plots and Cox regression analysis to estimate overall survival (OS) and disease-specific survival (DSS). Results: Adverse pathological features-including PNI, LVI, and ENE-showed varied distributions across OSCC subsites. After adjusting for gender, age, and tumor status, tongue cancer was associated with higher odds of adverse pathological factors: OR 1.76 (95% CI: 1.56-1.98) for PNI, OR 1.34 (95% CI: 1.17-1.53) for LVI, and OR 1.21 (95% CI: 1.08-1.35) for ENE. Notably, despite these aggressive pathological features, tongue tumors were associated with superior survival outcomes (5-year OS: 66%, 95% CI: 65-69%) compared to other subsites (5-year OS: 63%, 95% CI: 61-66%). Conclusions: PNI, LVI and ENE status showed distinct distributions among OSCC subsites, highlighting the need for tailored prognostic assessment according to subsites of OSCC and individualized management strategies.enAnatomical subsitesOral squamous cell carcinomaPathological featuresPrognostic factorsjournal article10.1016/j.amjoto.2026.10480341825151