Background/Objectives: Local and systemic factors, including nutritional status, influence the prognosis of oral squamous cell carcinoma (OSCC). Skeletal muscle mass (SMM) loss is a poor prognostic factor in older patients and those with cancer. Herein, we examined the SMM index (SMI), rates of surgical site infection (SSI), and prognosis of 92 patients (59 males and 33 females) who underwent resection and free flap reconstructive surgery (FFRS) between 2013 and 2021. Methods: Preoperative computed tomography was performed to measure SMM at L3. The median SMI was 45.94 and 38.03 cm2/m2in males and females, respectively. Patients were classified into low and high SMI groups based on median SMI, and overall survival (OS) was analyzed. Results: Overall, 47 (51.1%) and 45 (48.9%) patients had low and high SMIs, respectively. SSI occurred in 11 (12.0%) patients; wound dehiscence and delayed wound healing were observed in 22 (23.9%). SSI rates were not significantly different between the low and high SMI groups. Conversely, OS was significantly associated with age, pathological N (pN), extranodal extension (ENE), and SMI (high, 81.1%; low, 60.2%). Univariate analyses revealed significant associations between OS and age (≥65 vs. <65 years), SMI (low vs. high), pN (present vs. none), ENE (present vs. none), and albumin (<4.0 vs. ≥4.0 mg/dL). Cox multivariate analysis included SMI (low vs. high; hazard ratio [HR]: 2.339, 95% confidence interval [CI]: 1.008–5.429;p= 0.015) and ENE (present vs. none; HR: 7.727, 95% CI: 3.083–19.368;p< 0.001). Conclusions: SMI and ENE were identified as independent predictive factors of OS in patients with OSCC undergoing FFRS.
背景/目的：局部和全身因素，包括营养状况，影响口腔鳞状细胞癌（OSCC）的预后。骨骼肌质量（SMM）减少是老年患者和癌症患者的不良预后因素。本研究对2013年至2021年间接受切除及游离皮瓣重建手术（FFRS）的92例患者（59例男性和33例女性）的骨骼肌质量指数（SMI）、手术部位感染（SSI）发生率及预后进行了分析。方法：通过术前计算机断层扫描测量L3水平的SMM。男性和女性的中位SMI分别为45.94和38.03 cm²/m²。根据中位SMI将患者分为低SMI组和高SMI组，并分析总生存期（OS）。结果：总体而言，47例（51.1%）患者为低SMI，45例（48.9%）为高SMI。11例（12.0%）患者发生SSI；22例（23.9%）观察到伤口裂开和延迟愈合。低SMI组和高SMI组的SSI发生率无显著差异。相反，OS与年龄、病理N分期（pN）、结外侵犯（ENE）和SMI（高SMI组81.1%；低SMI组60.2%）显著相关。单变量分析显示，OS与年龄（≥65岁 vs. <65岁）、SMI（低 vs. 高）、pN（阳性 vs. 阴性）、ENE（阳性 vs. 阴性）和白蛋白（<4.0 vs. ≥4.0 mg/dL）存在显著关联。Cox多变量分析纳入SMI（低 vs. 高；风险比[HR]：2.339，95%置信区间[CI]：1.008–5.429；p=0.015）和ENE（阳性 vs. 阴性；HR：7.727，95% CI：3.083–19.368；p<0.001）。结论：SMI和ENE被确定为接受FFRS的OSCC患者OS的独立预测因素。
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