Introduction: Head and neck squamous cell carcinoma (HNSCC) remains burdened by high local recurrence rates, severely limiting long-term survival. Emerging evidence suggests that platelet-mediated systemic inflammation and angiogenesis facilitate residual tumor progression. This study evaluates the prognostic significance of preoperative platelet count as an independent predictor of local recurrence in patients undergoing curative-intent surgical resection for HNSCC.

Material and methods: This descriptive cross-sectional study, conducted at Shohada Hospital, Tabriz, enrolled 74 patients with surgically resectable head and neck squamous cell carcinoma using convenience sampling. Clinical and pathological data were systematically extracted to evaluate the prognostic significance of preoperative platelet count regarding local recurrence. Statistical comparisons and logistic regression were utilized to identify independent predictors, ensuring full adherence to established ethical standards.

Results: Preoperative thrombocytosis significantly correlated with local recurrence (336.5 vs. 230.7×10³ / µL; P<0.001). ROC analysis confirmed robust predictive accuracy (AUC 0.968; Sensitivity 90.0%; Specificity 90.7%) at an optimal cut-off of>267.9×10³/µL. Furthermore, multivariable logistic regression identified elevated platelet count as an independent predictor of local disease failure, even after adjusting for established clinicopathological variables (adjusted odds ratio [aOR] 3.42; 95% CI:1.12–10.45; P=0.031).

Conclusion: Baseline preoperative platelet count serves as a potent, noninvasive, and independent prognostic biomarker for predicting local recurrence in surgically resectable head and neck squamous cell carcinoma. Routine assessment of this hematological parameter may enhance patient stratification and guide postoperative surveillance strategies, potentially improving oncological outcomes.