Introduction: Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a widely used imaging tool for oral squamous cell carcinoma (OSCC). Preliminary studies indicate that quantification of tumor metabolic uptake may correlate with tumor hypoxia and aggressive phenotypes. Methods: Retrospective review of a consecutive cohort of OSCC (n = 98) with available pretherapeutic FDG-PET/CT, treated at the University Hospital Zurich. Clinicopathologico-radiological correlation between maximum standard uptake value (SUV max) of the primary tumor, immunohistochemical staining for hypoxia-related proteins glucose transporter 1 (GLUT1) and hypoxia-inducible factor 1-alpha (HIF1a), depth of invasion (DOI), lymph node metastasis, and outcome was examined. Results: Positive staining for GLUT1 and HIF1a on immunohistopathological analysis correlated with increased SUV max on pretherapeutic imaging and with increased DOI (Kruskal-Wallis, P = 0.037, and P = 0.008, respectively). SUV max and DOI showed a strong positive correlation (Spearman Rho, correlation coefficient = 0.451, P = 0.0003). An increase in SUV max predicted nodal metastasis (Kruskal-Wallis, P = 0.017) and poor local control (log rank, P = 0.047). Conclusion: In OSCC, FDG-PET-derived metabolic tumor parameter SUV max serves as a surrogate marker for hypoxia and can be used to predict tumor aggressiveness, with more invasive phenotypes and poorer local control.