Background: The nutritional risk index (NRI) is an excellent indicator of nutritional status and a significant prognostic factor in several malignancies, but the relationship between NRI and the prognosis of head and neck soft tissue sarcoma (HNSTS) patients remains unclear. The aim of this study was to investigate the role of NRI in patients with HNSTS. Methods: We retrospectively reviewed patients with HNSTS between 1990 and 2021. In order to determine the optimal cut-off value of NRI, the Maximally selected log-rank statistic was performed. We evaluated the effect of NRI on overall survival (OS) and progression-free survival (PFS) by using the Kaplan–Meier method and Cox regression analysis. Then, OS and PFS nomograms based on NRI were constructed. Results: In total, 436 HNSTS patients were included in this study. The optimal cut-off value of NRI was 99.34. Patients with low-NRI showed significantly worse OS and PFS than patients with high-NRI, respectively (5-year OS rate of 43.0 vs. 70.8%, 5-year PFS rate of 29.0 vs. 45.0%, all p < 0.05). In the multivariate analysis, distant metastasis, deep tumor depth, tumor grade, and NRI were prognostic factors for both PFS and OS, and treatment modality was associated with OS but not PFS. The concordance indexes (C-indexes) of OS and PFS nomograms were 0.794 (95% CI, 0.759–0.829) and 0.663 (95% CI, 0.626–0.700), respectively, which also performed well in the validation set. Conclusions: NRI is an independent predictor of OS and PFS in HNSTS patients. The validated nomograms based on NRI provide useful predictions of OS and PFS for patients with HNSTS.

Introduction: Recent advancements in surgical techniques and perioperative care have improved cancer survival rates, yet post-operative comorbidity and mortality remain a critical concern. Despite progress in cancer control, systematic analyses of long-term mortality trends and competing risks in surgery-intervened cancer populations are lacking. This study aimed to quantify temporal patterns of post-operative mortality causes across 21 solid cancers and identify dominant non-cancer risk factors to inform survivorship care strategies. Methods: This retrospective, population-based cohort study analyzed data from 3 424 671 patients (including 2 371 058 surgical cases) diagnosed with 21 solid cancers between 1992 and 2021, sourced from the Surveillance, Epidemiology, and End Results database. Competing risk models were applied to assess cumulative mortality rates from index-cancer, non-index-cancer, and non-cancer causes, with stratification by cancer type. Surgical interventions were evaluated across short-term (30-day) and long-term follow-up periods, with primary outcomes focused on mortality attribution and secondary outcomes on temporal dominance shifts. Results: In this population-based retrospective cohort study of 3 424 671 patients with 21 solid cancers (1992–2021), non-cancer deaths surpassed index-cancer mortality in 14 malignancies (e.g., prostate, breast, colorectal), accounting for 48.7% of post-surgical deaths, with cardiovascular diseases and infections as primary contributors. By the 2020s, non-cancer causes emerged as the leading mortality driver in these cancers. However, index-cancer mortality remained predominant in pancreatic, ovarian, and brain tumors, highlighting the persistent therapeutic gaps. Surgical resection significantly altered mortality profiles for cancer population, with a 95.7% increase in non-cancer mortality for lung cancer and an 87.3% increase for pancreatic cancer ( P < 0.001), underscoring the critical need for enhanced post-operative comorbidity management. While 1-month post-surgical mortality improved over three decades for most solid cancers, disparities persisted in brain, biliary tract, and colorectal cancers. These findings advocate for multidisciplinary strategies prioritizing non-cancer comorbidities, particularly cardiovascular and infectious risks, to optimize long-term survival in cancer survivors. Conclusion: This study highlights a paradigm shift in post-operative mortality, with no-cancer cause of deaths now surpassing cancer-related deaths in most solid tumors. These findings underscore the urgency of integrating multidisciplinary care targeting cardiovascular health and infection prevention into survivorship programs.