{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T06:18:21Z","timestamp":1771395501811,"version":"3.50.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Oral squamous cell carcinoma (OSCC) exhibits heterogeneous outcomes based on nodal status, complicating personalized prognosis. This study aimed to identify nodal-specific prognostic factors in OSCC by integrating metabolic metrics from\n                      <jats:sup>18<\/jats:sup>\n                      F-fluorodeoxyglucose Positron Emission Tomography\/Computed Tomography, body composition (L3 skeletal muscle index, L3-SMI), and key pathological features, to refine risk stratification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 147 OSCC patients (74 pN0, 73 pN+) who underwent curative resection and neck dissection. Associations between metabolic metrics, L3-SMI, pathological factors, and overall (OS) or progression-free survival (PFS) were evaluated using Cox regression. Internal bootstrap validation (1000 repetitions) was performed to assess the stability and potential bias of the prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In pN0 patients, tumor maximum standardized uptake value (T-SUVmax) &amp;gt;13.27 emerged as an independent predictor of poor OS (HR = 10.24,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.003) and PFS (HR = 8.23,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.002), which was validated by bootstrapping. Among pN+ patients, \u22653 positive lymph nodes significantly predicted worse outcomes (OS HR = 4.15,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001; PFS HR = 1.97,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.049), while higher L3-SMI served as a protective factor for survival (OS HR = 0.13,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.047; PFS HR = 0.18,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.024); both findings were supported by internal validation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We propose a nodal status-stratified approach for risk assessment in OSCC. For pN0 necks, high risk is characterized by elevated T-SUVmax, whereas in pN+ necks, high nodal burden and sarcopenia define increased risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1746241","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T05:33:52Z","timestamp":1771392832000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nodal status dictates divergent prognostic drivers in oral squamous cell carcinoma: metabolic burden in pN0 vs. sarcopenia and nodal burden in pN+"],"prefix":"10.3389","volume":"16","author":[{"given":"Shihui","family":"Shen","sequence":"first","affiliation":[{"name":"Department of General Dentistry, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wugang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhua","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yubo","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haihua","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Oncology, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Shanghai Ninth People\u2019s Hospital, Shanghai JiaoTong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41368-023-00249-w","article-title":"Oral squamous cell carcinomas: state of the field and emerging 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