{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T05:06:33Z","timestamp":1783919193078,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Swallowing dysfunction and long\u2010term gastrostomy tube dependence are common morbidities after oral cavity cancer resection with free flap reconstruction, highlighting the need for preoperative risk prediction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a multicenter retrospective pooled cohort study of patients with non\u2010metastatic oral cavity cancer undergoing free flap reconstruction. Firth's penalized logistic regression, LASSO, and random forest models were trained using 10\u2010fold cross\u2010validation and predictive performance was assessed via area under the receiver operator curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 500 patients (mean age 61.7\u2009years), 78 (16%) were gastrostomy tube dependent at 12\u2009months. The random forest model was most accurate in predicting 12\u2010month gastrostomy tube dependency (AUC; 0.77), with comparable performance from LASSO (AUC; 0.71) and Firth's penalized logistic regression (AUC; 0.70). Key predictors included TNM stage IV, T4 disease, unilateral neck dissection, reconstruction site, and no tongue resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The three models predicted 12\u2010month gastrostomy tube dependency after oral cavity free\u2010flap surgery with fair accuracy and novel predictors; larger multicenter datasets may further improve predictive performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70353","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T04:56:46Z","timestamp":1783918606000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Machine Learning and Statistical Models for Predicting Long Term Gastrostomy Tube Dependency in Patients Undergoing Major Oral Cavity Cancer Surgery With Free Flap Reconstruction"],"prefix":"10.1002","author":[{"given":"Amirpouyan","family":"Namavarian","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Alenazi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1376-8046","authenticated-orcid":false,"given":"Katrina","family":"Hueniken","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philopateer","family":"Ataalla","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Sunnybrook Health Sciences Center, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leba","family":"Sarkis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esmat","family":"Najjar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedyeh","family":"Ziai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0346-716X","authenticated-orcid":false,"given":"Christopher M. K. L.","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7973-3212","authenticated-orcid":false,"given":"Sharon","family":"Tzelnick","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Baskurt","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad U.","family":"Khalid","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Sunnybrook Health Sciences Center, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Princess Margaret Cancer Center \u2013 University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny J.","family":"Enepekides","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Sunnybrook Health Sciences Center, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Higgins","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Sunnybrook Health Sciences Center, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Hosni","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Princess Margaret Cancer Center, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezra","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Princess Margaret Cancer Center, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Princess Margaret Cancer Center, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Rudzicz","sequence":"additional","affiliation":[{"name":"Faculty of Computer Science, Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Vector Institute for Artificial Intelligence  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Eskander","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; 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