{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:31:41Z","timestamp":1787236301742,"version":"build-2736575974"},"reference-count":51,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Contralateral lymph node metastasis (CLNM) in oral squamous cell carcinoma (OSCC) represents a major clinical challenge, in patients with a clinically contralateral node-negative neck. Individualized risk stratification is crucial to guide decisions on elective contralateral neck dissection. This study aimed to synthesize existing evidence and apply Bayesian Monte Carlo Simulation (MCS) to estimate CLNM probability across various clinic-pathological scenarios. Methods: A systematic search of PubMed, PubMed Central, and Embase (2000\u20132024) identified 26 eligible studies. Effect sizes for seven key risk factors\u2014midline-crossing tumours, extranodal extension (ENE), \u22652 ipsilateral lymph nodes, depth of invasion (DOI) &gt;10 mm, perineural invasion and lymphovascular invasion (PNI-LVI), poor differentiation, and floor of mouth subsite\u2014were computed and incorporated into a Bayesian logistic model. Using the No-U-Turn Sampler (NUTS) in RStan, 100,000 virtual patient profiles were simulated to generate posterior probabilities of CLNM. Results: The baseline CLNM risk for lateralized tumours without additional risk factors was 4.2%. Single risk factors increased probability substantially: midline-crossing tumours (31.7%), ENE (27.4%), and \u22652 ipsilateral nodes (24.9%). Combinations of risk factors amplified the risk non-linearly: the presence of a midline-crossing tumour, ENE, and \u22652 ipsilateral nodes yielded a 76.8% CLNM probability, and the presence of all seven risk factors increased it to 93.7%. Risk tiers were classified from minimal (&lt;20%) to very high (&gt;50%) to guide clinical decision-making. Conclusions: This MCS-based model reveals that CLNM risk increases multiplicatively with the presence of various high-risk features. The simulation supports bilateral neck management in high-risk patients and observation in low-risk cases. Prospective validation is needed to integrate this model into routine clinical practice and to guide patient-specific surgical planning.<\/jats:p>","DOI":"10.3390\/diagnostics15212668","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T02:03:48Z","timestamp":1761185028000},"page":"2668","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Bayesian Monte Carlo Simulation Based on Systematic Review for Personalized Risk Stratification of Contralateral Lymph Node Metastasis in Oral Squamous Cell Carcinoma"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1420-7366","authenticated-orcid":false,"given":"Karthik N.","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Head and Neck Oncology, Sri Shankara Cancer Foundation, Bangalore 560004, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4050-9106","authenticated-orcid":false,"given":"M. P.","family":"Sreeram","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Oncology, Sri Shankara Cancer Foundation, Bangalore 560004, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1952-4061","authenticated-orcid":false,"given":"Prajwal","family":"Dange","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Oncology, Sri Shankara Cancer Foundation, Bangalore 560004, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1363-8559","authenticated-orcid":false,"given":"Andres Coca","family":"Pelaz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Hospital Universitario Central de Asturias, ISPA, IUOPA, CIBERONC, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Piazza","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, School of Medicine, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-5814","authenticated-orcid":false,"given":"Remco de","family":"Bree","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Hospital Universitario Central de Asturias, ISPA, IUOPA, CIBERONC, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9671-0784","authenticated-orcid":false,"given":"Orlando","family":"Guntinas-Lichius","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Institute of Phoniatry\/Pedaudiology, Jena University Hospital, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0481-156X","authenticated-orcid":false,"given":"Luiz Paulo","family":"Kowalski","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo 05403-000, SP, Brazil"},{"name":"Department of Head and Neck Surgery, A. C. Camargo Cancer Center, S\u00e3o Paulo 01525-001, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head Neck Surgery, SIU School of Medicine, Southern Illinois University, Springfield, IL 62702, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0445-112X","authenticated-orcid":false,"given":"Primo\u017e","family":"Strojan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Su\u00e1rez","sequence":"additional","affiliation":[{"name":"Universidad de Oviedo, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Homma","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo 060-0808, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Takes","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3063-0890","authenticated-orcid":false,"given":"Juan Pablo","family":"Rodrigo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Hospital Universitario Central de Asturias, ISPA, IUOPA, CIBERONC, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2768","authenticated-orcid":false,"given":"Marc","family":"Hamoir","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, St Luc University Hospital and King Albert II Cancer Institute, UC Louvain, 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avraham","family":"Eisbruch","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Civantos","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Miami Miller, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3725-8051","authenticated-orcid":false,"given":"Anna Lu\u00edza Damaceno","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, University of S\u00e3o Paulo Medical School, S\u00e3o Paulo 05403-000, SP, Brazil"},{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7956-6709","authenticated-orcid":false,"given":"Alessandra","family":"Rinaldo","sequence":"additional","affiliation":[{"name":"ENT Unit, Policlinico Citt\u00e0 di Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0006-6352","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"Wierzbicka","sequence":"additional","affiliation":[{"name":"Regional Specialist Hospital Wroclaw, Research & Development Centre, 51-124 Wroclaw, Poland"},{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8247-8002","authenticated-orcid":false,"given":"Alfio","family":"Ferlito","sequence":"additional","affiliation":[{"name":"Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1002\/ijc.33588","article-title":"Cancer statistics for the year 2020: An overview","volume":"149","author":"Ferlay","year":"2021","journal-title":"Int. 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