A multivariate analysis for LRR for these four variables revealed that PTEN status, N-stage and extranodal spread are all independent significant factors, indicating that the PTEN status could have an additive value in determining the prognosis of advanced-stage HNSCC, next to the already used clinical factors of N-stage and extranodal spread. This evidence concerns the gene PTEN and head and neck squamous cell carcinoma.