Clinical Impact of Rapid Recurrence in Oral Tongue Squamous Cell Carcinoma and a Nomogram for Early Identification of High-Risk Patients

OBJECTIVES: This study investigated the effects of clinicopathological variables on rapid recurrence (defined as recurrence within 3 months) in oral tongue squamous cell carcinoma (OTSCC) and developed prediction models using multiple data combinations. METHODS: A total of 944 patients with OTSCC were divided into two groups according to recurrence timing: the rapid recurrence group (RRG, n=89) and the non-rapid or no-recurrence group (n=855). Treatment-related variables were collected and analyzed to identify factors associated with overall survival (OS) and rapid recurrence. A logistic regression-based prediction model was developed to estimate the probability of rapid recurrence. Model performance was evaluated using 10-fold cross-validation, leave-group-out cross-validation, and calibration analysis. RESULTS: Lower OS rates were observed with increasing age, advanced T (T3-4) and N (N1-3) stages, higher maximum preoperative positron emission tomography standardized uptake value (PET SUVmax), and rapid recurrence. In multivariable logistic regression analysis, advanced T (T2-T4) and N3 stages, positive resection margins, and higher PET SUVmax were associated with rapid recurrence, whereas postoperative chemoradiation demonstrated a protective effect. A nomogram was constructed to facilitate individualized risk estimation by integrating these clinical variables. CONCLUSION: Rapid recurrence was strongly associated with poor oncological outcomes in OTSCC. The validated prediction model, incorporating imaging and pathological variables, may help identify high-risk patients and support tailored treatment and surveillance strategies.