{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T14:20:10Z","timestamp":1784384410984,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","award":["ZR2024QH547"],"award-info":[{"award-number":["ZR2024QH547"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp;amp; Neck"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Head and neck Merkel cell carcinoma (HNMCC) is a rare but aggressive malignancy characterized by high recurrence rates and an uncertain survival benefit from postoperative radiotherapy (PORT). This study aimed to develop and validate a prognostic nomogram for risk stratification and to evaluate the survival benefit of PORT across risk groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with surgically resected, non\u2010metastatic HNMCC were retrospectively identified. Independent prognostic factors for overall survival (OS) were identified via univariate and multivariate Cox regression. A nomogram was constructed and internally validated using time\u2010dependent receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA). Patients were stratified into high\u2010 and low\u2010risk groups based on nomogram scores, and the impact of PORT was assessed within each risk category using Kaplan\u2013Meier analysis and log\u2010rank tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1776 patients were included. Six variables\u2014age, sex, marital status, race, T stage, and N stage\u2014were independently associated with OS and used to construct the nomogram. The model demonstrated superior discriminative ability and calibration performance compared to traditional staging systems, and DCA confirmed improved clinical utility. Among high\u2010risk patients, PORT significantly improved 5\u2010 and 10\u2010year OS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas no significant survival benefit was observed in the low\u2010risk group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study presents a validated nomogram that accurately predicts survival and supports risk\u2010adapted use of PORT in HNMCC. Selective application of PORT based on individualized risk may optimize outcomes while minimizing overtreatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70023","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:34:14Z","timestamp":1756377254000},"page":"184-194","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Postoperative Radiotherapy for Head and Neck Merkel Cell Carcinoma: Sometimes, Less Is More"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2456-5413","authenticated-orcid":false,"given":"Yuan","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8960-2264","authenticated-orcid":false,"given":"Di","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine  Jinan China"},{"name":"Department of Medical Oncology Qilu Hospital of Shandong University  Jinan Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qihao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Medicine, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6859-8390","authenticated-orcid":false,"given":"Jiaoyang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine  Jinan China"},{"name":"Medical Integration and Practice Center, Cheeloo College of Medicine Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.77"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.10.028"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.44127"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13143506"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24148"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2014.3052"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyz153"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2019.03.004"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20510"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2013.00276"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2022.05.005"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20134"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2006.07.9319"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.02.015"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.10.022"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2023.11.020"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2023.05.042"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.12.072"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2019.0267"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2021.05.014"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26626"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24776"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.02.034"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010022\u201012201\u2010z"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010016\u20105266\u20104"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1515\/med\u20102024\u20101103"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2024.10.096"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.142.6.693"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010006\u20109327\u2010y"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdr318"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw042"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010009\u20100615\u20101"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31333"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2019.3078"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078\u20100432.Ccr\u201023\u20100395"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2020\u20100184"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010019\u201007831\u20109"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70023","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70023","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:22:50Z","timestamp":1782746570000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/hed.70023"],"URL":"https:\/\/doi.org\/10.1002\/hed.70023","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,28]]},"assertion":[{"value":"2025-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}