A cohort study developed and validated a serum metabolite-based prognostic scoring system (MetaboScore) to predict recurrence risk in oral cavity squamous cell carcinoma (OCSCC) among patients with resected, advanced-stage disease and high betel quid exposure.
The MetaboScore, comprising 19 metabolites, was independently associated with increased risk of local, regional, and distant recurrence, as well as lower disease-free and disease-specific survival, beyond conventional staging.
Importance Improved methods are needed to predict recurrence in oral cavity squamous cell carcinoma (OCSCC). However, to date, no metabolome studies have fully explored the prediction of OCSCC relapse patterns and survival.
Objective To identify serum metabolites associated with OCSCC recurrence and develop and validate a prognostic scoring system.
Design, Setting, and Participants This retrospective cohort study was conducted at a single tertiary academic center and enrolled patients with histologically confirmed, surgically resected first primary advanced-stage OCSCC from betel quid–chewing areas. Patients underwent primary surgery between February 2007 and May 2018, with follow-up data systematically collected through a prospectively maintained institutional registry. Data were analyzed from December 2024 to September 2025.









