{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:38:49Z","timestamp":1787567929678,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background: Head and neck cutaneous squamous cell carcinoma (HNcSCC) presents intersecting oncologic, functional, and reconstructive challenges. Although numerous clinicopathologic factors have been associated with recurrence, metastasis, and survival, their relationship with reconstructive complexity and patient-centered outcomes remains insufficiently studied. This review aimed to examine how established oncologic risk factors might inform reconstructive planning while distinguishing measured reconstructive evidence from hypothesis-generating clinical inferences. Methods: A structured PubMed\/MEDLINE search conducted through 15 July 2026 was used to identify the literature addressing clinicopathologic prognostic factors in HNcSCC. Twenty-nine prognostic publications were retained for structured charting. Additional reconstructive, functional, aesthetic, and patient-reported outcome sources were identified through reference-list screening and were used solely for narrative contextualization. Because no dedicated multi-database systematic search of reconstructive outcomes was performed, the article is presented as a structured narrative review and hypothesis-generating research framework rather than a systematic review of reconstructive evidence. Results: The prognostic literature reported associations between adverse oncologic outcomes and factors including tumor size and depth, perineural invasion, lymphovascular invasion, poor differentiation, immunosuppression, recurrent disease, positive margins, nodal involvement, and extranodal extension. However, most of these studies did not measure post-excision defect characteristics, reconstructive technique, wound complications, functional recovery, scar quality, aesthetic outcomes, or patient-reported outcomes. Direct reconstructive evidence was limited and predominantly derived from site-specific, mixed-histology, technical, or methodological publications. Consequently, clinicopathologic factors should be regarded as potential upstream variables for future investigation rather than validated predictors of reconstructive outcomes. Conclusions: Current evidence supports oncologic risk stratification more strongly than prediction of reconstructive difficulty or patient-centered outcomes in HNcSCC. Prospective studies should jointly measure patient, tumor, treatment-field, defect, reconstructive, functional, aesthetic, and patient-reported variables. The proposed framework is intended to guide such research and is not a validated clinical prediction model.<\/jats:p>","DOI":"10.3390\/reports9030280","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:20:02Z","timestamp":1787563202000},"page":"280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Clear Margins: Oncologic Risk and Reconstructive Planning in Head and Neck Cutaneous Squamous Cell Carcinoma\u2014A Structured Narrative Review"],"prefix":"10.3390","volume":"9","author":[{"given":"Iris-Iuliana","family":"Adam","sequence":"first","affiliation":[{"name":"\u2018St. Constantin\u2019 Hospital, 500299 Bra\u0219ov, Romania"},{"name":"Dental Elite Clinics, 500187 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5020-8825","authenticated-orcid":false,"given":"Liliana","family":"Vecerzan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cLucian Blaga\u201d University, 550169 Sibiu, Romania"},{"name":"\u2018Dr. Alexandru Augustin\u2019 Military Hospital, 550024 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Moldovan","sequence":"additional","affiliation":[{"name":"\u2018St. Constantin\u2019 Hospital, 500299 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca-Gabriela","family":"Miulescu","sequence":"additional","affiliation":[{"name":"\u2018St. Constantin\u2019 Hospital, 500299 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru-Petru","family":"Ciucu","sequence":"additional","affiliation":[{"name":"Dental Elite Clinics, 500187 Bra\u0219ov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0237-702X","authenticated-orcid":false,"given":"Alina-Bianca","family":"Iacob","sequence":"additional","affiliation":[{"name":"\u2018St. Constantin\u2019 Hospital, 500299 Bra\u0219ov, Romania"},{"name":"Emergency Clinical County Hospital T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Ormeni\u0219an","sequence":"additional","affiliation":[{"name":"Emergency Clinical County Hospital T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.hoc.2018.08.001","article-title":"Cutaneous Squamous Cell Carcinoma","volume":"33","author":"Waldman","year":"2019","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jaad.2017.08.059","article-title":"Cutaneous Squamous Cell Carcinoma: Incidence, Risk Factors, Diagnosis, and Staging","volume":"78","author":"Que","year":"2018","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"113252","DOI":"10.1016\/j.ejca.2023.113252","article-title":"European Consensus-Based Interdisciplinary Guideline for Invasive Cutaneous Squamous Cell Carcinoma: Part 2. Treatment\u2014Update 2023","volume":"193","author":"Stratigos","year":"2023","journal-title":"Eur. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6634","DOI":"10.3390\/curroncol30070487","article-title":"Aggressive Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Review","volume":"30","author":"Desai","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s11864-017-0484-y","article-title":"Overview of the 8th Edition TNM Classification for Head and Neck Cancer","volume":"18","author":"Huang","year":"2017","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1097\/01.prs.0000279145.95073.ed","article-title":"Aesthetic and functional outcome following nasal reconstruction","volume":"120","author":"Mureau","year":"2007","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.bjps.2007.12.017","article-title":"Facial attractiveness and abnormality of nasal reconstruction patients and controls assessed by laypersons","volume":"61","author":"Moolenburgh","year":"2008","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/j.bjps.2007.09.018","article-title":"Aesthetic outcome after nasal reconstruction: Patient versus panel perception","volume":"61","author":"Moolenburgh","year":"2008","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"138e","DOI":"10.1097\/PRS.0b013e3181d0ae2b","article-title":"Nasal reconstruction","volume":"125","author":"Menick","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.cps.2009.02.015","article-title":"Nasal reconstruction with a forehead flap","volume":"36","author":"Menick","year":"2009","journal-title":"Clin. Plast. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1055\/s-0028-1095887","article-title":"Scalp and calvarial reconstruction","volume":"22","author":"Lin","year":"2008","journal-title":"Semin. Plast. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"54e","DOI":"10.1097\/01.prs.0000179188.25019.6c","article-title":"Reconstruction of acquired scalp defects: An algorithmic approach","volume":"116","author":"Leedy","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.cps.2009.02.001","article-title":"Reconstruction of scalp and forehead defects","volume":"36","author":"Seitz","year":"2009","journal-title":"Clin. Plast. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.otohns.2003.09.016","article-title":"Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale","volume":"130","author":"Stewart","year":"2004","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1097\/01.PRS.0000122207.28773.56","article-title":"The Patient and Observer Scar Assessment Scale: A reliable and feasible tool for scar evaluation","volume":"113","author":"Draaijers","year":"2004","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1001\/jamadermatol.2015.4994","article-title":"Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: A systematic review and meta-analysis","volume":"152","author":"Thompson","year":"2016","journal-title":"JAMA Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/S1470-2045(08)70178-5","article-title":"Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: A prospective study","volume":"9","author":"Brantsch","year":"2008","journal-title":"Lancet Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1001\/jamadermatol.2013.2139","article-title":"Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: A 10-year, single-institution cohort study","volume":"149","author":"Schmults","year":"2013","journal-title":"JAMA Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s40463-021-00529-7","article-title":"Prognostic factors of head and neck cutaneous squamous cell carcinoma: A systematic review","volume":"50","author":"Lubov","year":"2021","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"00652","DOI":"10.2340\/actadv.v101.347","article-title":"Age-related Differences in Tumour Characteristics and Prognostic Factors for Disease Progression in Cutaneous Squamous Cell Carcinoma of the Head and Neck","volume":"102","author":"Leus","year":"2022","journal-title":"Acta Derm. Venereol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1001\/jamadermatol.2025.0128","article-title":"Risk Factor Number and Recurrence, Metastasis, and Disease-Related Death in Cutaneous Squamous Cell Carcinoma","volume":"161","author":"Ran","year":"2025","journal-title":"JAMA Dermatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.jaad.2024.01.040","article-title":"Cumulative incidence and risk factors for cutaneous squamous cell carcinoma metastases in organ transplant recipients: The Skin Care in Organ Transplant Patients in Europe-International Transplant Skin Cancer Collaborative metastases study, a prospective multicenter study","volume":"90","author":"Genders","year":"2024","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1016\/j.jaad.2025.02.052","article-title":"Identifying the impact of minor risk factors in Brigham and Women\u2019s Hospital stage T1 cutaneous squamous cell carcinomas on risk of poor outcomes: A retrospective cohort study","volume":"92","author":"Shahwan","year":"2025","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3385","DOI":"10.1002\/hed.28259","article-title":"Validation of Current Staging Systems in HNCSCC: A Multinational Cohort Study","volume":"47","author":"Girardi","year":"2025","journal-title":"Head Neck"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4481","DOI":"10.1245\/s10434-019-07865-z","article-title":"Sentinel Node Biopsy in 105 High-Risk Cutaneous SCCs of the Head and Neck: Results of a Multicenter Prospective Study","volume":"26","author":"Mooney","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.jaad.2013.11.034","article-title":"A prospective evaluation of the clinical, histologic, and therapeutic variables associated with incidental perineural invasion in cutaneous squamous cell carcinoma","volume":"70","author":"Campoli","year":"2014","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1002\/hed.27017","article-title":"Facial nerve perineural spread from cutaneous squamous cell carcinoma of the head and neck: A single institution analysis of epidemiology, treatment, survival outcomes, and prognostic factors","volume":"44","author":"Schachtel","year":"2022","journal-title":"Head Neck"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"E32","DOI":"10.1177\/0145561316095010-1106","article-title":"Prognostic factors in metastatic cutaneous squamous cell carcinoma of the head and neck","volume":"95","author":"Bachar","year":"2016","journal-title":"Ear Nose Throat J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1001\/jamaoto.2024.3103","article-title":"Determinants of Prognosis in Head and Neck Cutaneous Squamous Cell Carcinoma with Nodal Metastases","volume":"150","author":"Ebrahimi","year":"2024","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.jaad.2025.04.029","article-title":"Lymphovascular invasion is an independent predictor of metastasis and disease-specific death in cutaneous squamous cell carcinoma: A multicenter retrospective study","volume":"93","author":"Hirotsu","year":"2025","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00405-025-09887-8","article-title":"Survival rates in head and neck cutaneous squamous cell carcinoma with nodal metastases: A multicenter study","volume":"283","author":"Fermi","year":"2026","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2054","DOI":"10.1002\/cncr.30601","article-title":"A multi-institutional comparison of outcomes of immunosuppressed and immunocompetent patients treated with surgery and radiation therapy for cutaneous squamous cell carcinoma of the head and neck","volume":"123","author":"Manyam","year":"2017","journal-title":"Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.anorl.2017.09.006","article-title":"Prognostic factors for parotid metastasis of cutaneous squamous cell carcinoma of the head and neck","volume":"135","author":"Bobin","year":"2018","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"de Melo, G.M., das Neves, M.C., Romero, R.D., Rosano, M., Martines, R.T., Takimoto, R.M., Greggio, B., Palumbo, M.D.N., Brodskyn, F., and Gatti, A.P. (2026). Prognostic Factors of Locally Advanced Cutaneous Squamous Cell Carcinoma in Head and Neck Region in Transplanted Patients. Diagnostics, 16.","DOI":"10.3390\/diagnostics16030404"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1002\/hed.23102","article-title":"Concurrent primary and metastatic cutaneous head and neck squamous cell carcinoma: Analysis of prognostic factors","volume":"35","author":"McLean","year":"2013","journal-title":"Head Neck"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jaad.2025.09.042","article-title":"Impact of immunosuppression on cutaneous squamous cell carcinoma outcomes","volume":"94","author":"Klein","year":"2026","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1002\/hed.27912","article-title":"Predictors of distant metastatic recurrence in head and neck cutaneous squamous cell carcinoma with lymph node metastases treated with curative intent: A multicenter study","volume":"47","author":"Ebrahimi","year":"2025","journal-title":"Head Neck"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1001\/jamaoto.2025.2110","article-title":"Prognostic Subgroups for Disease-Free Survival with Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Secondary Analysis of a Randomized Clinical Trial","volume":"151","author":"Porceddu","year":"2025","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1002\/hed.26512","article-title":"Prognostic value of the 8th edition American Joint Commission Cancer nodal staging system for patients with head and neck cutaneous squamous cell carcinoma: A multi-institutional study","volume":"43","author":"Luk","year":"2021","journal-title":"Head Neck"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3235","DOI":"10.1002\/hed.26369","article-title":"The American Joint Committee on Cancer staging for metastatic head and neck cutaneous squamous cell carcinoma: A multi-institutional study of within-stage heterogeneity and impact on prognostic performance","volume":"42","author":"Ebrahimi","year":"2020","journal-title":"Head Neck"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3275","DOI":"10.1002\/hed.28251","article-title":"Impact of Extranodal Extension in Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Systematic Review and Meta-Analysis","volume":"47","author":"Costantino","year":"2025","journal-title":"Head Neck"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1002\/jso.26410","article-title":"A critical analysis of the 8th edition TNM staging for head and neck cutaneous squamous cell carcinoma with lymph node metastases and comparison to N1S3 stage and ITEM risk score: A multicenter study","volume":"123","author":"Ebrahimi","year":"2021","journal-title":"J. Surg. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"104855","DOI":"10.1016\/j.oraloncology.2020.104855","article-title":"Number of nodal metastases and the American Joint Committee on cancer staging of head and neck cutaneous squamous cell carcinoma: A multicenter study","volume":"111","author":"Ebrahimi","year":"2020","journal-title":"Oral. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1097\/PRS.0b013e3181de2260","article-title":"Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: An algorithm for treatment","volume":"126","author":"Mureau","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1097\/PRS.0b013e3181e09515","article-title":"An algorithm for oncologic scalp reconstruction","volume":"126","author":"Iblher","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1002\/hed.21999","article-title":"Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer: A 10-year experience","volume":"34","author":"Chao","year":"2012","journal-title":"Head Neck"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1001\/jamadermatol.2013.2456","article-title":"Evaluation of American Joint Committee on Cancer tumor staging for cutaneous squamous cell carcinoma and a proposed alternative tumor staging system","volume":"149","author":"Kanetsky","year":"2013","journal-title":"JAMA Dermatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1200\/JCO.2012.48.5326","article-title":"Evaluation of American Joint Committee on Cancer, International Union Against Cancer, and Brigham and Women\u2019s Hospital tumor staging for cutaneous squamous cell carcinoma","volume":"32","author":"Karia","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/j.surg.2021.04.019","article-title":"Clinician perspectives on the factors influencing prognostic stratification by the American Joint Commission on Cancer Head and Neck Cutaneous Squamous Cell Carcinoma Staging","volume":"170","author":"Watts","year":"2021","journal-title":"Surgery"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jaad.2025.02.076","article-title":"riSCC: A personalized risk model for the development of poor outcomes in cutaneous squamous cell carcinoma","volume":"93","author":"Jeanselme","year":"2025","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/j.jaad.2025.07.029","article-title":"Satellitosis or in-transit metastasis in cutaneous squamous cell carcinoma: Risk factors and the prognostic significance","volume":"93","author":"Pahalyants","year":"2025","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1097\/DSS.0000000000000488","article-title":"Lymph Node Metastasis in Cutaneous Head and Neck Squamous Cell Carcinoma","volume":"41","author":"Silberstein","year":"2015","journal-title":"Dermatol. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"113251","DOI":"10.1016\/j.ejca.2023.113251","article-title":"European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 1. Diagnostics and prevention\u2014Update 2023","volume":"193","author":"Stratigos","year":"2023","journal-title":"Eur. J. Cancer"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"51","DOI":"10.7326\/M18-1376","article-title":"PROBAST: A tool to assess the risk of bias and applicability of prediction model studies","volume":"170","author":"Wolff","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"55","DOI":"10.7326\/M14-0697","article-title":"Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD statement","volume":"162","author":"Collins","year":"2015","journal-title":"Ann. Intern. Med."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/280\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:56:14Z","timestamp":1787565374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,23]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["reports9030280"],"URL":"https:\/\/doi.org\/10.3390\/reports9030280","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,23]]}}}