ObjectivesTo explore the predictive value of inflammatory‐nutritional score (INS) and a nomogram for survivals in head and neck soft tissue sarcoma (HNSTS) patients with negative resection margins (R0).MethodsClinical characteristics and hematological features of 315 HNSTS patients underwent R0 surgery were analyzed.ResultsThe 5‐year overall survival (OS) rate, 3‐year recurrence‐free survival rate and disease‐free survival (DFS) rate were 77.3%, 61.0% and 55.4%, respectively. High INS was associated with a deep tumor location (p < 0.001), high tumor grade (p < 0.001), and advanced AJCC stage (p < 0.001). The low‐risk group (INS 0) exhibited a higher 5‐year OS rate and 3‐year DFS rate than others (87.6% vs. 81.3% vs. 53.3%, p < 0.001; 62.2% vs. 56.9% vs. 37.9%, p = 0.007). The INS (p = 0.023), tumor depth (p < 0.001), pT classification (p = 0.022), pN classification (p < 0.001) and tumor grade (p < 0.001) were independent survival predictors. Moreover, a novel nomogram for predicting OS was generated and assessed by the concordance index, exhibiting a better performance than the p7TNMG classification alone (p < 0.001).ConclusionsFor R0 resected HNSTS patients, the oncological outcomes can be predicted using the INS system and a specific nomogram.