Introduction:
Oral squamous cell carcinoma (OSCC) is the most prevalent malignancy of the oral cavity, carrying a disproportionately high burden in South Asia. Histopathological grade is a recognised prognostic marker, yet its relationship with cervical nodal involvement in OSCC of the gingivobuccal complex has not been adequately characterised in the Pakistani population.

Material and methods:
This descriptive cross-sectional study enrolled 257 consecutive patients with biopsy-confirmed OSCC of the gingivobuccal complex. Histopathological grading was performed by a single accredited laboratory. Cervical nodal status was assessed clinically and by contrast-enhanced computed tomography, since not all patients underwent neck dissection.

Results:
Mean age was 48.78 ± 16.62 years; 138 (53.70%) participants were male and 119 (46.30%) female. Clinically and radiologically detected cervical nodal involvement was present in 173 participants (67.32%). Poorly differentiated tumours were most frequent (38.9%), followed by well differentiated (31.5%), moderately differentiated (24.9%), and undifferentiated (4.7%). Nodal involvement was comparable in well and moderately differentiated tumours (58.02% and 53.12%) and rose sharply in poorly differentiated (81.00%) and undifferentiated tumours (91.67%), a difference that was highly statistically significant (p < 0.001). Neither age (p = 0.723) nor sex (p = 0.192) was significantly associated with nodal involvement.

Conclusions:
Histopathological grade showed a strong association with cervical nodal involvement in OSCC of the gingivobuccal complex, whereas age and sex did not. Early diagnosis and grade-informed neck evaluation may help improve outcomes, although prospective multivariable studies are needed before these findings can guide routine practice.