{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:13:44Z","timestamp":1789456424893,"version":"build-2803163510"},"reference-count":19,"publisher":"Wiley","issue":"4","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":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current staging systems for head and neck cutaneous squamous cell carcinoma (HNCSCC), such as AJCC8 and BWH, often fail to adequately stratify high\u2010risk patients, particularly due to the exclusion of important biological and host factors. This study aimed to identify independent prognostic factors for HNCSCC outcomes in the largest multi\u2010institutional retrospective series to date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>De\u2010identified data from 8,610 primary HNCSCC tumors, treated with curative intent surgery across multiple international centers, were analyzed. Outcomes included local recurrence (LR), locoregional metastasis (LM), distant metastasis (DM), and disease\u2010specific death (DSD). Multivariable Fine\u2013Gray subdistribution hazard regression models with robust standard errors clustered at the patient level were fitted to generate exploratory hypotheses regarding independent hazard determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow\u2010up of 31.4 months (IQR 14.2\u201352.8), the cumulative incidence was 3.3% for LR, 2.7% for LM, 0.5% for DM, and 1.2% for DSD. Multivariable analysis confirmed that tumor diameter, poor differentiation, deep invasion, and large\u2010caliber perineural invasion (LCPNI) were the strongest predictors, being significantly associated with at least three of the four outcomes. Notably, factors currently excluded from or weighted differently in staging systems also proved critical: Immunosuppression was significantly associated with LR (SHR 2.03) and DSD (SHR 1.70); and lymphovascular invasion (LVI) was independently associated with LM (SHR 3.00). Poor differentiation demonstrated high prognostic impact, being a significant predictor for all four endpoints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tumor diameter, poor differentiation, deep invasion, LCPNI, immunosuppression status, and LVI are the most critical independent factors for HNCSCC prognosis. Our multi\u2010institutional data provide a robust framework for hypothesis generation, highlighting that incorporating host biological features and non\u2010anatomic variables could significantly refine future staging system discussions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70325","type":"journal-article","created":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T19:05:37Z","timestamp":1783883137000},"page":"584-593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Factors in Primary Head and Neck Cutaneous Squamous Cell Carcinoma: A Large\u2010Scale, Multi\u2010Institutional Competing\u2010Risks Analysis"],"prefix":"10.1002","volume":"134","author":[{"given":"F\u00e1bio Murad\u00e1s","family":"Girardi","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery Ana Nery Hospital Santa Cruz do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian David Cardona","family":"Machado","sequence":"additional","affiliation":[{"name":"Department of Dermatology Complejo Asistencial Universitario de Salamanca Salamanca"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Wysong","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Nebraska Medical Center Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina A.","family":"Ran","sequence":"additional","affiliation":[{"name":"Department of Dermatology Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5655-9792","authenticated-orcid":false,"given":"Emily E.","family":"Granger","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Maryland School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shlomo A.","family":"Koyfman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison T.","family":"Vidimos","sequence":"additional","affiliation":[{"name":"Department of Dermatology Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Dermatology The Ohio State University Medical Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2259-1150","authenticated-orcid":false,"given":"Kathryn T.","family":"Shahwan","sequence":"additional","affiliation":[{"name":"Department of Dermatology The Ohio State University Medical Center Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey E.","family":"Hirotsu","sequence":"additional","affiliation":[{"name":"Stanford School of Medicine Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Carucci","sequence":"additional","affiliation":[{"name":"Department of Dermatology New York University School of Medicine New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joi B.","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Dermatology Geisel School of Medicine at Dartmouth Hanover NH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron R.","family":"Mangold","sequence":"additional","affiliation":[{"name":"Department of Dermatology Mayo Clinic Arizona Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Texas Southwestern School of Medicine Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Brodland","sequence":"additional","affiliation":[{"name":"Zitelli and Brodland P.C. 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