Comminuted mandibular fractures (CMFs) pose significant challenges to surgeons for their serious complications and poor outcomes. We aimed at proposing a classification with treatment algorithm of each category for CMFs. Patients with CMFs were retrospectively reviewed and classified into five categories: Type I: relatively good occlusion, no or slightly displaced fragments, no continuity destruction or bone defect; Type II: relatively good occlusion, damaged morphology, low comminution degree but intact continuity without bone defect; Type III: damaged morphology and higher comminution degree with intact continuity and relatively good occlusion; Type IV: high comminution, impaired continuity and poor occlusion without segmental bone defect; Type V: segmental bone defect. Conservative treatment, open reduction and internal fixation or microvascular osteocutaneous free flap transplantation was performed, accordingly. Demographics, perioperative data, complications and reasons for reoperations were recorded. The chi-square test was used for statistical analysis. In total, 109 patients were included in the study. After surgery, in the following group, 5 manifested infections, 1 manifested bone non-union, and 2 experienced reoperations, while in the unfollowing group, 10 manifested infections, 5 manifested bone non-union and 8 experienced reoperations. The OCCS classification and algorithm for CMFs achieve better outcomes and with lower complication rate.

Background: This study aimed to evaluate the derived neutrophil to lymphocyte ratio (dNLR) in predicting the prognosis of patients with locally advanced oral squamous cell carcinoma (LAOSCC) and to assess the survival benefits from docetaxel, cisplatin, and 5-fluorouracil (5-FU) (TPF) induction chemotherapy (IC). Methods: Patients from a phase III trial involving TPF IC in stage III/IVA OSCC patients (NCT01542931) were enrolled. Receiver operating characteristic curves were constructed, and the area under the curve was computed to determine dNLR cutoff points. Kaplan–Meier survival estimates and Cox proportional hazards models were used for longitudinal analysis. Results: A total of 224 patients were identified (median age: 55.4 years; range: 26 to 75 years; median follow-up: 90 months; range: 3.2 to 93 months). The cutoff point for the dNLR was 1.555. Multivariate analysis showed that the dNLR was an independent negative predictive factor for survival (overall survival (OS): hazard ratio (HR) = 1.154, 95% confidence interval (CI): 1.018–1.309, p = 0.025; disease-free survival (DFS): HR = 1.123, 95% CI: 1.000–1.260, p = 0.050; local recurrence-free survival (LRFS): HR = 1.134, 95% CI: 1.002–1.283, p = 0.047; distant metastasis-free survival (DMFS): HR = 1.146, 95% CI: 1.010–1.300, p = 0.035). A low dNLR combined with cTNM stage III disease predicted benefit from TPF IC for the patients [OS (χ² = 4.674, p = 0.031), DFS (χ² = 7.134, p = 0.008), LRFS (χ² = 5.937, p = 0.015), and DMFS (χ² = 4.832, p = 0.028)]. Conclusions: The dNLR is an independent negative predictive factor in LAOSCC patients. Patients with cTNM stage III disease and a low dNLR can benefit from TPF IC.

Oral squamous cell carcinoma (OSCC) remains a highly aggressive malignancy with limited responsiveness to anti‐PD‐1 immunotherapy. Recent neoadjuvant studies combining VEGFR‐2 inhibition (VEGFR2i) with anti‐PD‐1 (aPD‐1) have yielded markedly improved pathological responses, suggesting a VEGFR‐2‐dependent immunoregulatory mechanism. Here, we identify a PD‐L1‐expressing CD66b ⁺ neutrophil‐enriched tumor‐associated population as a critical immunosuppressive population enriched in VEGFR‐2‐high OSCC tumors and associated with increased metastatic propensity and inferior patient outcomes. Using multiplex immunohistochemistry, scRNA‐seq, and flow cytometry, we demonstrate that VEGFR‐2‐overexpressing OSCC cells drive robust GM‐CSF secretion, which in turn induces PD‐L1 upregulation in neutrophils. Mechanistically, VEGFR‐2 activation promotes STAT6 phosphorylation and nuclear translocation, enabling direct transcriptional activation of CSF2 . GM‐CSF subsequently activates STAT5 and mTOR/S6K signaling in neutrophils, thereby enhancing PD‐L1 protein synthesis. Functionally, these PD‐L1 ⁺ TANs suppress CD8 ⁺ T‐cell proliferation, augment T‐cell exhaustion, and diminish cytotoxicity. Importantly, VEGFR‐2 inhibition or GM‐CSF neutralization restored CD8 ⁺ T‐cell function and improved responsiveness to anti‐PD‐1 therapy in vivo, whereas exogenous GM‐CSF impaired VEGFR2i/aPD‐1 efficacy. Collectively, our findings reveal a previously unrecognized VEGFR‐2/STAT6/ CSF2 axis that licenses neutrophil‐mediated immune suppression in OSCC. These data provide mechanistic rationale and preclinical support for targeting the VEGFR‐2/GM‐CSF‐neutrophil axis to improve the efficacy of PD‐1 blockade in OSCC.

Background: While observational data have shown that derived neutrophil-to-lymphocyte ratio (dNLR) correlates with the prognosis of locally advanced resectable oral squamous cell carcinoma (LAROSCC), its predictive utility for neoadjuvant therapy effect remains unexplored. This study investigates the association between dynamic dNLR changes and therapeutic efficacy in LAROSCC patients receiving anti-PD-1 (camrelizumab) and VEGFR2 inhibitor (apatinib) combination neoadjuvant therapy. Patients and methods: This study retrospectively analyzed a pioneer, single-center, open-label, non-randomized phase I trial (NCT04393506). Twenty-one LAROSCC patients were enrolled between April and December 2020. After excluding 1 patient who withdrew prior to treatment initiation, 20 patients completed neoadjuvant therapy [three cycles of intravenous camrelizumab (200 mg, d1, d15, and d29) plus daily oral apatinib (250 mg) until 5 days pre-surgery] followed by radical resection surgery. Eighteen patients subsequently received adjuvant radiotherapy/chemoradiotherapy. Results: Among 20 evaluable patients [median age, 56.4 (30–71) years], major pathological response (≤ 10% residual viable tumor cells) demonstrated distinct dNLR kinetics: a progressive decline during treatment ( P = 0.042). Post-intervention dNLR independently correlated with residual tumor burden (β = 19.334, P = 0.006) in the multivariate linear regression. Multiplex immunohistochemistry of surgical specimens showed dNLR-increased patients exhibited enhanced neutrophil infiltration ( R ² = 0.439, P = 0.002) and immunosuppressive tumor microenvironment signatures. Conclusions: Dynamic dNLR reduction during neoadjuvant camrelizumab-apatinib therapy associates with improved pathological response, immune-active tumor microenvironment remodeling, and favorable clinical trajectories in LAROSCC. These findings position dNLR as a pragmatic biomarker for real-time monitoring of immunotherapeutic efficacy, which are exploratory and highlight the need for validation in larger, prospective cohorts.

Background: To evaluate derived neutrophil to lymphocyte ratio (dNLR) in predicting the prognosis of patients with locally advanced oral squamous cell carcinoma (LAOSCC), and the survival benefits from docetaxel, cisplatin, and 5-FU (TPF) induction chemotherapy (IC); Methods: Patients from a phase III trial involving TPF IC in stage III/IVA OSCC patients (NCT01542931) were enrolled. Receiver operating characteristic curves were built and area under the curve was computed to determine dNLR cutoff points. Kaplan-Meier estimates of survival and Cox proportional hazards models were used for longitudinal analysis; (3) Results: 224 patients were identified (median age, 55.4 yr; range, 26 to 75 yr; median follow-up, 90 months; range, 3.2 to 93 months); Cutoff points for dNLR was 1.555. Multivariate analysis showed dNLR was an independent negative predictive factor for survival (overall survival (OS): hazard ratio (HR) = 1.154, 95% confidence interval (CI): 1.018-1.309, P = 0.025, disease-free survival (DFS): HR = 1.123, 95% CI: 0.260-1.000, P = 0.050, local recurrence-free survival (LRFS): HR = 1.134, 95% CI: 1.002-1.283, P = 0.047, distant metastasis-free survival (DMFS): HR = 1.146, 95% CI: 1.010-1.300, P = 0.035). Low dNLR combining cTNM stage III disease predicts benefit from TPF IC for the patients [OS (χ² = 4.674, P = 0.031), DFS (χ² = 7.134, P = 0.008), LRFS (χ² = 5.937, P = 0.015) and DMFS (χ² = 4.832, P = 0.028)]; (4) Conclusions: dNLR is an independent negative predictive factor in LAOSCC patients. Patients of cTNM stage III and low dNLR can benefit from TPF IC.