{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:18:12Z","timestamp":1760059092978,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Local and systemic factors, including nutritional status, influence the prognosis of oral squamous cell carcinoma (OSCC). Skeletal muscle mass (SMM) loss is a poor prognostic factor in older patients and those with cancer. Herein, we examined the SMM index (SMI), rates of surgical site infection (SSI), and prognosis of 92 patients (59 males and 33 females) who underwent resection and free flap reconstructive surgery (FFRS) between 2013 and 2021. Methods: Preoperative computed tomography was performed to measure SMM at L3. The median SMI was 45.94 and 38.03 cm2\/m2 in males and females, respectively. Patients were classified into low and high SMI groups based on median SMI, and overall survival (OS) was analyzed. Results: Overall, 47 (51.1%) and 45 (48.9%) patients had low and high SMIs, respectively. SSI occurred in 11 (12.0%) patients; wound dehiscence and delayed wound healing were observed in 22 (23.9%). SSI rates were not significantly different between the low and high SMI groups. Conversely, OS was significantly associated with age, pathological N (pN), extranodal extension (ENE), and SMI (high, 81.1%; low, 60.2%). Univariate analyses revealed significant associations between OS and age (\u226565 vs. &lt;65 years), SMI (low vs. high), pN (present vs. none), ENE (present vs. none), and albumin (&lt;4.0 vs. \u22654.0 mg\/dL). Cox multivariate analysis included SMI (low vs. high; hazard ratio [HR]: 2.339, 95% confidence interval [CI]: 1.008\u20135.429; p = 0.015) and ENE (present vs. none; HR: 7.727, 95% CI: 3.083\u201319.368; p &lt; 0.001). Conclusions: SMI and ENE were identified as independent predictive factors of OS in patients with OSCC undergoing FFRS.<\/jats:p>","DOI":"10.3390\/cancers17101729","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T13:59:43Z","timestamp":1747835983000},"page":"1729","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Skeletal Muscle Mass and Surgical Site Infection and Prognosis in Patients Undergoing Free Flap Reconstructive Surgery for Oral Squamous Cell Carcinoma: A Single-Center, Retrospective Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Atsuro","family":"Noguchi","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba 305-8576, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7231-7478","authenticated-orcid":false,"given":"Kenji","family":"Yamagata","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba 305-8576, Japan"},{"name":"Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Fukuzawa","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba 305-8576, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaoru","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shohei","family":"Takaoka","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba 305-8576, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihiko","family":"Uchida","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba 305-8576, Japan"},{"name":"Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Ishibashi-Kanno","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba 305-8576, Japan"},{"name":"Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuru","family":"Sekido","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Bukawa","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba 305-8576, Japan"},{"name":"Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104530","DOI":"10.1016\/j.oraloncology.2019.104530","article-title":"Low skeletal muscle mass is a strong predictive factor for surgical complications and a prognostic factor in oral cancer patients undergoing mandibular reconstruction with a free fibula flap","volume":"101","author":"Ansari","year":"2020","journal-title":"Oral. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1002\/micr.30668","article-title":"Evaluation of overall and disease-free survival in patients with free flaps for oral cancer resection","volume":"40","author":"Makiguchi","year":"2020","journal-title":"Microsurgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"106608","DOI":"10.1016\/j.oraloncology.2023.106608","article-title":"Association of sarcopenia with oncologic outcomes of primary treatment among patients with oral cavity cancer: A systematic review and meta-analysis","volume":"147","author":"Graves","year":"2023","journal-title":"Oral. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1002\/micr.30494","article-title":"Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancer","volume":"39","author":"Makiguchi","year":"2019","journal-title":"Microsurgery"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1002\/hed.27113","article-title":"Association of low skeletal muscle mass and systemic inflammation with surgical complications and survival after microvascular flap reconstruction in patients with head and neck cancer","volume":"44","author":"Chargi","year":"2022","journal-title":"Head. Neck"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"106598","DOI":"10.1016\/j.oraloncology.2023.106598","article-title":"Impact of low skeletal muscle mass on postoperative complications in head and neck cancer patients undergoing free flap reconstructive surgery\u2014A systematic review and meta-analysis","volume":"147","author":"Ansari","year":"2023","journal-title":"Oral. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1056\/NEJMoa032641","article-title":"Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer","volume":"350","author":"Bernier","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1056\/NEJMoa032646","article-title":"Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck","volume":"350","author":"Cooper","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.ijom.2019.09.011","article-title":"Impact of sarcopenia on postoperative surgical site infections in patients undergoing flap reconstruction for oral cancer","volume":"49","author":"Nakamura","year":"2020","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1186\/s12957-020-01908-6","article-title":"Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor","volume":"18","author":"Maeda","year":"2020","journal-title":"World J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jcms.2023.01.014","article-title":"Evaluation of sarcopenia and sarcopenic obesity in patients affected by oral squamous cell carcinoma: A retrospective single-center study","volume":"51","author":"Improta","year":"2023","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/j.ijom.2022.02.008","article-title":"Association of preoperative low skeletal muscle mass with postoperative complications after selective neck dissection","volume":"51","author":"Ansari","year":"2022","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0196-6553(99)70088-X","article-title":"Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee","volume":"27","author":"Mangram","year":"1999","journal-title":"Am. J. Infect. Control"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1002\/hed.27000","article-title":"The effectiveness of skeletal muscle evaluation at the third cervical vertebral level for computed tomography-defined sarcopenia assessment in patients with head and neck cancer","volume":"44","author":"Vangelov","year":"2022","journal-title":"Head. Neck"},{"doi-asserted-by":"crossref","unstructured":"Yoon, J.K., Jang, J.Y., An, Y.S., and Lee, S.J. (2021). Skeletal muscle mass at C3 may not be a strong predictor for skeletal muscle mass at L3 in sarcopenic patients with head and neck cancer. PLoS ONE, 16.","key":"ref_15","DOI":"10.1371\/journal.pone.0254844"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.oraloncology.2016.09.006","article-title":"Feasibility of using head and neck CT imaging to assess skeletal muscle mass in head and neck cancer patients","volume":"62","author":"Swartz","year":"2016","journal-title":"Oral. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s00405-019-05307-w","article-title":"Interobserver agreement of skeletal muscle mass measurement on head and neck CT imaging at the level of the third cervical vertebra","volume":"276","author":"Bril","year":"2019","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.anl.2021.03.021","article-title":"Sarcopenia with inflammation as a predictor of survival in patients with head and neck cancer","volume":"48","author":"Yamahara","year":"2021","journal-title":"Auris Nasus Larynx"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4440","DOI":"10.1002\/cncr.30901","article-title":"Feasibility and preliminary effects of resistance training and nutritional supplements during versus after radiotherapy in patients with head and neck cancer: A pilot randomized trial","volume":"123","author":"Sandmael","year":"2017","journal-title":"Cancer"},{"doi-asserted-by":"crossref","unstructured":"Wobith, M., and Weimann, A. (2021). Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery. Nutrients, 13.","key":"ref_20","DOI":"10.3390\/nu13082655"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/10\/1729\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:36:43Z","timestamp":1760031403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/10\/1729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,21]]},"references-count":20,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["cancers17101729"],"URL":"https:\/\/doi.org\/10.3390\/cancers17101729","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2025,5,21]]}}}