{
  "abstract": "Aims To develop and validate a multifactorial risk model for predicting disease-free survival (DFS) in oral squamous cell carcinoma (OSCC) by integrating pathological features with systemic and tissue-based inflammatory markers.Methods In this retrospective multicentre study of 81 OSCC patients, systemic inflammatory blood markers and tissue-based spatial immune profiles (assessed via multiplex immunohistochemistry) were evaluated. Multivariate Cox regression analysis was performed to identify independent predictors of the primary outcome, DFS. A prognostic nomogram was constructed based on significant variables (p < 0.05), and model performance was evaluated using the concordance index (C-index).Results The final multifactorial model identified Stage 4b (adjusted HR (aHR)=10.68; p=0.003), high pre-treatment absolute neutrophil count (aHR=6.04; p=0.003) and high post-treatment lymphocyte-to-monocyte ratio (aHR=3.63; p<0.001) as significant systemic predictors. Within the tumour microenvironment, high CD68 +/CD3+ (aHR=3.60; p=0.006) and high CD66b−CD15+/CD68+ (aHR=2.68; p=0.013) ratios at the tumour centre (TC) were independent predictors of DFS. The integrated risk model achieved a C-index of 0.82, demonstrating superior predictive accuracy compared with traditional staging and other risk models.Conclusions The integration of systemic inflammatory markers and TC immune ratios with the pathological staging shows potential to enhance DFS prediction in OSCC. Pending future external validation, this multidimensional model may provide a useful framework for individualised risk stratification, potentially assisting in personalising post-treatment surveillance and adjuvant strategies for high-risk patients.",
  "authors": [
    {
      "affiliations": [
        "Center for Research in Oral Cancer, Faculty of Dental Science, University of Peradeniya, Peradeniya, Sri Lanka",
        "Department of Oral & Maxillofacial Clinical Sciences, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia",
        "Oral Cancer Research & Coordinating Center, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Anand Ramanathan"
    },
    {
      "affiliations": [
        "Oral Cancer Research & Coordinating Center, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Wan Maria Nabillah Ghani"
    },
    {
      "affiliations": [
        "Department of Oral Maxillofacial Surgery, Penang General Hospital, Ministry of Health, Penang, Malaysia"
      ],
      "name": "Sarah Sabrina Zakaria"
    },
    {
      "affiliations": [
        "Department of Oral & Maxillofacial Clinical Sciences, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Zakiah Mat Ripen"
    },
    {
      "affiliations": [
        "Department of Oral Maxillofacial Surgery, QE Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia"
      ],
      "name": "Saravanan Gopalan"
    },
    {
      "affiliations": [
        "Department of Oral Maxillofacial Surgery, QE Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia"
      ],
      "name": "Marzuki Zainal Abidin"
    },
    {
      "affiliations": [
        "Department of Oral Medicine & Pathology, QE Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia"
      ],
      "name": "Fairuz Abdul Rahman"
    },
    {
      "affiliations": [
        "Faculty of Dental Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka"
      ],
      "name": "Rasika Ekanayaka"
    },
    {
      "affiliations": [
        "Institute of Molecular Cell Biology (IMCB), Agency of Science, Technology and Research (ASTAR), Singapore"
      ],
      "name": "Joe Poh Sheng Yeong"
    },
    {
      "affiliations": [
        "Institute of Molecular Cell Biology (IMCB), Agency of Science, Technology and Research (ASTAR), Singapore"
      ],
      "name": "Craig Joseph"
    },
    {
      "affiliations": [
        "National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan"
      ],
      "name": "Yi-Hsin Yang"
    },
    {
      "affiliations": [
        "Department of Oral & Maxillofacial Clinical Sciences, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia",
        "Oral Cancer Research & Coordinating Center, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Zuraiza Mohamad Zaini"
    },
    {
      "affiliations": [
        "Department of Oral Pathology, Faculty of Dental Science, University of Peradeniya, Peradeniya, Sri Lanka",
        "RAK College of Dental Sciences, RAK Medical & Health Sciences University, Ras Al-Khaimah, Ras al Khaimah, UAE"
      ],
      "name": "Samadarani Bogahawatte Samarakoon Mudiyanselage Siriwardena"
    },
    {
      "affiliations": [
        "Department of Oral & Maxillofacial Clinical Sciences, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia",
        "Oral Cancer Research & Coordinating Center, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Siti Mazlipah Ismail"
    },
    {
      "affiliations": [
        "Department of Oral & Maxillofacial Clinical Sciences, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia",
        "Oral Cancer Research & Coordinating Center, Universiti Malaya Faculty of Dentistry, Federal Territory of Kuala Lumpur, Malaysia"
      ],
      "name": "Tilakaratne Wanninayake Mudiyanselage"
    }
  ],
  "title": "Development and internal validation of a multifactorial risk model for predicting disease-free survival in oral squamous cell carcinoma",
  "uid": "1ae4355b-ed25-563c-9430-8374cc0320ea"
}