Previous studies have demonstrated that the tumour–stroma ratio (TSR) and tumour budding are of prognostic value for oral squamous cell carcinomas (OSCCs). The aim of this study was to evaluate the prognostic significance of those histological parameters, individually and in combination, for OSCC.

The TSR and tumour budding (the presence of five or more buds at the invasive front) were estimated in 254 patients with OSCC. The clinicopathological association was investigated with a chi‐square test, and the prognostic significance (cancer‐specific survival and disease‐free survival) was verified with Kaplan–Meier analysis and the Cox proportional hazard model. The TSR (≥50%, stroma‐rich) was significantly and independently associated with both shortened cancer‐specific survival and poor disease‐free survival, whereas tumour budding was significantly associated with reduced cancer‐specific survival. The TSR/tumour budding model was independently associated with a high risk of cancer mortality and recurrence (disease‐free survival). In patients with early‐stage tumours (clinical stage I and II, n = 103), the TSR, tumour budding and the TSR/tumour budding model were significantly associated with both cancer‐related death and recurrence, whereas, in advanced‐stage tumours (clinical stage III and IV, n = 144), only the TSR and the TSR/tumour budding model were significantly associated with cancer‐specific survival.

The TSR, tumour budding and their combination provide significant information on OSCC outcome, suggesting that their incorporation in the routine evaluation of histopathological specimens might be useful in prognostication for OSCC patients.