{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:00:08Z","timestamp":1791669608179,"version":"4.3.4"},"reference-count":26,"publisher":"Korean Society of Otorhinolaryngology-Head and Neck Surgery","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011892","name":"Kaohsiung Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CORPG8P0691"],"award-info":[{"award-number":["CORPG8P0691"]}],"id":[{"id":"10.13039\/501100011892","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["e-ceo.org"],"crossmark-restriction":true},"short-container-title":["Clin Exp Otorhinolaryngol"],"published-print":{"date-parts":[[2026,8,31]]},"abstract":"<jats:p>Objectives. This study aimed to evaluate the prognostic value of the margin-to-depth of invasion ratio (MDR) in patients with locally advanced oral squamous cell carcinoma (LAOSCC) who underwent curative surgery followed by adjuvant concurrent chemoradiotherapy (CCRT).Methods. We analyzed 422 consecutive patients with LAOSCC treated at a single institution between 2007 and 2017. MDR was defined as the ratio of the closest surgical margin (mm) to the tumor depth of invasion (mm). Survival outcomes, including overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS), were assessed. The optimal MDR cutoff was determined by X-tile analysis and validated using repeated k-fold cross-validation.Results. The optimal MDR cutoff for predicting survival was 0.35. Patients with MDR \u22650.35 (high MDR, n=205) demonstrated significantly better 5-year OS (66.1% vs. 47.6%, P&lt;0.001), CSS (77.5% vs. 57.4%, P&lt;0.001), and RFS (71.5% vs. 53.8%, P=0.001) than those with MDR &lt;0.35 (low MDR, n=217). In multivariate analysis, low MDR remained an independent adverse prognostic factor for OS (hazard ratio [HR], 1.612; P=0.005), CSS (HR, 2.028; P=0.001) and RFS (HR, 1.501; P=0.033). Among patients with adequate margins (\u22655 mm), MDR retained significant prognostic value (OS, P=0.008; CSS, P=0.001; RFS, P=0.015). Cross-validation confirmed the robustness of the MDR threshold value of 0.35 across all survival endpoints.Conclusion. MDR is an independent prognostic marker in LAOSCC treated with surgery and adjuvant CCRT. A cutoff of 0.35 effectively stratifies survival risk, even among patients with adequate surgical margins. Incorporating MDR into postoperative assessment could refine risk stratification and guide individualized follow-up and adjuvant treatment planning.<\/jats:p>","DOI":"10.21053\/ceo.2025-00339","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T23:31:07Z","timestamp":1768865467000},"page":"281-292","update-policy":"https:\/\/doi.org\/10.21053\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Margin-to-Depth of Invasion Ratio on Oncologic Outcomes in Locally Advanced Oral Cancer Treated With Surgery and Chemoradiotherapy"],"prefix":"10.21053","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6877-1579","authenticated-orcid":true,"given":"Ming-Hsien","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7311-8638","authenticated-orcid":true,"given":"Yu-Tsai","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5335-9744","authenticated-orcid":true,"given":"Hui-Ching","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4055-1686","authenticated-orcid":true,"given":"Chao-Hui","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"},{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tai-Lin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7952-7160","authenticated-orcid":true,"given":"Hui","family":"Lu","sequence":"additional","affiliation":[{"name":"Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2525-1060","authenticated-orcid":true,"given":"Wen-Ling","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Cosmetics and Fashion Styling, Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6690-6038","authenticated-orcid":true,"given":"Chih-Yen","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"},{"name":"Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0165-771X","authenticated-orcid":true,"given":"Fu-Min","family":"Fang","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan"},{"name":"Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1894","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","type":"journal-article"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-09736-2","type":"journal-article"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa032641","type":"journal-article"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa032646","type":"journal-article"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14010015","type":"journal-article"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2021.105499","type":"journal-article"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24075","type":"journal-article"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2023.06.023","type":"journal-article"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2021.105358","type":"journal-article"},{"key":"ref10","first-page":"1305","type":"journal-article","volume-title":"Stratification of surgical margin distances by the millimeter on local recurrence in oral cavity cancer: a systematic review and meta-analysis","author":"Young","year":"2023"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1200\/go.23.00144","type":"journal-article"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2016.01.010","type":"journal-article"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2024.107102","type":"journal-article"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2024.106726","type":"journal-article"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27428","type":"journal-article"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2018-0411-sa","type":"journal-article"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.4238","type":"journal-article"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14225702","type":"journal-article"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1002\/jso.26386","type":"journal-article"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5497-4","type":"journal-article"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23286","type":"journal-article"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2024.11.016","type":"journal-article"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2014.02.032","type":"journal-article"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3634-5","type":"journal-article"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2023.106572","type":"journal-article"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-016-2015-9","type":"journal-article"}],"container-title":["Clinical and Experimental Otorhinolaryngology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-ceo.org\/upload\/pdf\/ceo-2025-00339.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-ceo.org\/journal\/view.php?doi=10.21053\/ceo.2025-00339","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-ceo.org\/upload\/pdf\/ceo-2025-00339.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:54:45Z","timestamp":1788497685000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-ceo.org\/journal\/view.php?doi=10.21053\/ceo.2025-00339"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.21053\/ceo.2025-00339","relation":{},"ISSN":["1976-8710","2005-0720"],"issn-type":[{"value":"1976-8710","type":"print"},{"value":"2005-0720","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"assertion":[{"value":"2025-11-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-19","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}