{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T14:51:02Z","timestamp":1784386262339,"version":"3.55.0"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T00:00:00Z","timestamp":1703203200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The significance of different histological spreading patterns of tumor tissue in oral tongue squamous cell carcinoma (TSCC) is well known. Our aim was to construct a numeric parameter on a continuous scale, that is, the modified Polsby\u2013Popper (MPP) score, to describe the aggressiveness of tumor growth and infiltration, with the potential to analyze hematoxylin and eosin\u2010stained whole slide images (WSIs) in an automated manner. We investigated the application of the MPP score in predicting survival and cervical lymph node metastases as well as in determining patients at risk in the context of different surgical margin scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed a semiautomated image analysis pipeline to detect areas belonging to the tumor tissue compartment. Perimeter and area measurements of all detected tissue regions were derived, and a specific mathematical formula was applied to reflect the perimeter\/area ratio in a comparable, observer\u2010independent manner across digitized WSIs. We demonstrated the plausibility of the MPP score by correlating it with well\u2010established clinicopathologic parameters. We then performed survival analysis to assess the relevance of the MPP score, with an emphasis on different surgical margin scenarios. Machine learning models were developed to assess the relevance of the MPP score in predicting survival and occult cervical nodal metastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The MPP score was associated with unfavorable tumor growth and infiltration patterns, the presence of lymph node metastases, the extracapsular spread of tumor cells, and higher tumor thickness. Higher MPP scores were associated with worse overall survival (OS) and tongue carcinoma\u2010specific survival (TCSS), both when assessing all pT\u2010categories and pT1\u2010pT2 categories only; moreover, higher MPP scores were associated with a significantly worse TCSS in cases where a cancer\u2010free surgical margin of &lt;5\u2009mm could be achieved on the main surgical specimen. This discriminatory capacity remained constant when examining pT1\u2010pT2 categories only. Importantly, the MPP score could successfully define cases at risk in terms of metastatic disease in pT1\u2010pT2 cancer where tumor thickness failed to exhibit a significant predictive value. Machine learning (ML) models incorporating the MPP score could predict the 5\u2010year TCSS efficiently. Furthermore, we demonstrated that machine learning models that predict occult cervical lymph node involvement can benefit from including the MPP score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We introduced an objective, quantifiable, and observer\u2010independent parameter, the MPP score, representing the aggressiveness of tumor growth and infiltration in TSCC. We showed its prognostic relevance especially in pT1\u2010pT2 category TSCC, and its possible use in ML models predicting TCSS and occult lymph node metastases.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6824","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T13:53:55Z","timestamp":1703253235000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The modified <scp>Polsby\u2013Popper<\/scp> score, a novel quantitative histomorphological biomarker and its potential to predict lymph node positivity and cancer\u2010specific survival in oral tongue squamous cell carcinoma"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4739-736X","authenticated-orcid":false,"given":"Tam\u00e1s D\u00e1niel","family":"Cs\u0171ry","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head &amp; Neck Surgery University Hospital Erlangen, 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