Aims To evaluate whether lymph node ratio (LNR) provides superior prognostic stratification compared to conventional nodal (pN) staging in oral cavity squamous cell carcinoma (OCSCC). Methodology A retrospective analysis of 1612 patients undergoing curative-intent surgery for OCSCC was performed. LNR, defined as the ratio of metastatic to dissected lymph nodes, was stratified into low (<0.05), intermediate (0.05–0.20), and high (>0.20) groups. Disease-free survival (DFS) and overall survival (OS) were assessed using Kaplan–Meier analysis and Cox regression. Multivariable models compared the prognostic performance of LNR and pN staging. Results LNR demonstrated a strong, stepwise association with outcomes. High LNR (>0.20) was associated with inferior DFS (HR 3.5, p<0.001) and OS (HR 6.0, p<0.001). In contrast, pN staging showed inferior discriminatory performance. On multivariable analysis, LNR remained independently predictive of survival, whereas pN staging did not consistently retain significance when adjusted for LNR. The combination of high LNR and extranodal extension (ENE) identified an ultra–high-risk subgroup with the poorest outcomes. Conclusion LNR outperforms conventional nodal staging in prognostic stratification and better reflects the biological burden of nodal disease. Incorporation of LNR, particularly in combination with ENE, may refine risk stratification and guide treatment decisions in OCSCC. Conflict of Interest No conflicts of interest to declare.