Introduction: Radiotherapy is crucial in controlling life-threatening bleeding associated with advanced cervical cancer. The objective was to describe our experience in managing severe bleeding with hemostatic radiotherapy in cervical cancer and to evaluate its effectiveness. Methodology: A retrospective, descriptive study was conducted of patients with cervical cancer treated with hemostatic radiotherapy between March 2021 and January 2023 at Dalal Jamm hospital radiotherapy center. Treatment efficacy was assessed using the WHO bleeding score both before and after radiotherapy. A statistical analysis was performed by calculating the absolute frequencies for qualitative variables and comparing the frequencies using a Chi-square test. For quantitative variables, means and standard deviations were calculated and a Student's t-test was used to compare the means. The significance threshold was set at a p-value of less than 0.05. Results: The mean age was 51.3 ± 10.6 years. Squamous cell carcinoma accounted for 87% of cases. Tumor stage III-IV accounted for 60.9% of patients. Before radiotherapy, 82.6% of patients had grade 3 vaginal bleeding. Radiotherapy was administered as a single dose in all patients, with a dose of 8 Gy in 82.6% and 6 Gy in 17.4% of cases. Radiotherapy controlled bleeding in 95.7% (95% CI: [78.1-99.9], p<0.001) of patients, with a complete response in 73.9% (95% CI: [51.6 - 89.8], p=0.035) of them. The mean duration of control of metrorrhagia was 2 ± 0.69 days. The mean hemoglobin level was 8.2 ± 1.8 g/dL before radiotherapy and 8.7 ± 1.5 g/dL after radiotherapy. Conclusion: Single-dose hemostatic radiotherapy (6 or 8 Gy) is an effective short-term method for controlling life-threatening metrorrhagia associated with cervical cancer in Senegal. Keywords: hemostatic radiotherapy; cervical cancer; palliative care; metrorrhagia; Senegal.

INCENP and CDCA8 predict neoadjuvant chemotherapy response and outcomes in esophageal squamous cell carcinoma

Introduction Pleural effusion, an atypical accumulation of fluid in the pleural space, has been identified as a potential indicator of several diseases, including lung cancer. The presence of biomarkers in malignant pleural effusion has been a subject of investigation; however, the expression of microRNAs has received limited attention. The objective of this study is to present a narrative review of the current scientific literature regarding the presence of microRNAs in malignant pleural effusion and their association as new biomarkers in the diagnosis of lung cancer. Method A comprehensive search was conducted using the databases: PubMed, ScienceDirect, and EBSCO to identify all original scientific articles published through 30 April 2025. The following terms were utilized in the search: “MicroRNA AND pleural effusion AND lung cancer”, “microRNA AND pleural effusion AND lung adenocarcinoma”, “microRNA AND pleural effusion AND lung squamous cell carcinoma”, “miRNA AND pleural effusion”, miRNA AND pleural effusion AND lung cancer”, “miRNA AND pleural effusion AND lung adenocarcinoma”, “miRNA AND pleural effusion AND lung squamous cell carcinoma”. Results A total of 17 studies were identified that distinguished between 106 microRNAs. These studies demonstrated the most significant overexpression and downexpression in lung cancer patients compared to patients without malignancy. However, eight of these studies distinguished between 17 microRNAs expressions and exhibited elevated area under the curve values, sensitivity, and specificity for the involvement in several hallmarks of lung cancer. Conclusion The regulatory mechanisms governing microRNAs in malignant pleural effusion are intricate and involve multiple genes that play pivotal roles in several cancer mechanisms. These mechanisms encompass but are not limited to, processes such as cell growth, migration, drug resistance, proliferation, apoptosis, invasion, angiogenesis, and apoptosis.

A study on the association between TP53 Arg72Pro, XRCC1 Arg399Gln, GSTP1 Ile105Val, and GSTM3 indel and the risk of cutaneous squamous cell carcinoma: a systematic review and meta-analysis.

Head and neck squamous cell carcinoma (HNSCC) presents significant therapeutic challenges owing to its elevated recurrence rate and resistance to chemotherapeutic interventions. Tumor organoid models serve as essential platforms for investigating tumor physiology and pathological functions in vivo for its similarities in recapitulating the spatial structure of HNSCC. We employed HPSCC organoids from typical cell line and patient tissues, which faithfully recapitulated the tumor architecture, combined with CRISPR/Cas9 screening and TCGA-HNSCC database analysis. We identified SREBP1, a master regulator of lipid metabolism, as a key molecule whose expression escalates during HNSCC progression and correlates with improved patient survival and chemotherapy response. Functional studies demonstrated that SREBP1 downregulation conferred resistance to cisplatin and reduced cell death in both organoid and xenograft models in human hypopharyngeal carcinoma (HPSCC). We also found that the downregulation of SREBP1 was associated with enhanced resistance to cisplatin and a reduction in cell death in HPSCC-organoid models ex vivo and xenograft mouse models in vivo. Our findings establish SREBP1-mediated lipid rewiring as a critical determinant of HNSCC pathogenesis and treatment outcomes. Consequently, our model offers a promising solution for the swift and accurate evaluation of chemotherapy efficacy and identifies SREBP1 as a potential therapeutic target in HPSCC.

This research aimed to quantify the incidence and risk factors for all-cause early mortality (defined as death within 3 months of diagnosis) versus cancer-specific early mortality in patients with nasopharyngeal squamous cell carcinoma (NPSCC). Data on NPSCC patients diagnosed between 2004 and 2014 were retrieved from the Surveillance, Epidemiology, and End Results database. Early mortality was defined as survival less than or equal to 3 months. Logistic regression was employed to identify determinants associated with both overall and cancer-specific early mortality. Among 1891 eligible patients, 176 (9.3%) died within 3 months of diagnosis, including 156 (8.2%) whose deaths were cancer-related. Univariate analysis revealed that older age, single/divorced/widowed status, poorly differentiated histology, advanced T category, advanced N category, and distant metastasis were significantly linked to both overall and cancer-specific early mortality. After multivariable adjustment, older age, unmarried status, lower histologic grade, high T stage, and metastatic disease remained independent predictors of overall and cancer-specific early mortality. The advanced nodal stage was additionally associated with cancer-specific early mortality (all P < 0.05). Elderly patients, aggressive tumor biology (poor differentiation, advanced T/N stage, distant metastasis), and unmarried status independently predict early mortality in NPSCC.

Residual or recurrent esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (CRT) is a therapeutic challenge. Salvage surgery is invasive, and endoscopic resection is limited by radiation-induced fibrosis. Argon plasma coagulation (APC) and photodynamic therapy (PDT) are less invasive salvage options, however their role in depth-oriented organ-preserving strategies remains unclear. We analyzed 52 consecutive patients with residual or recurrent ycT1-2 ESCC who underwent CRT. APC is indicated for ycT1a lesions, and PDT is indicated for ycT1b-T2 lesions, with flexibility. We evaluated the survival rates, adverse events, and predictors of local failure. Thirteen patients underwent APC, and 39 underwent PDT. The overall local complete response rate was 78.8% (92.3% APC and 74.3% PDT). During a median follow-up of 24.7months (range, 1.9-110.5months), the 2-year overall survival, progression-free survival, disease-specific survival, and esophagectomy-free survival rates were 82.8%, 44.0%, 86.7%, and 75.9%, respectively. Adverse events occurred in 30.8% of APC patients and 41.0% of PDT patients, all of which were manageable without treatment-related mortality. Multivariate analysis identified ycT2 stage (hazard ratio [HR]: 9.61, 95% confidence interval [CI]: 1.04-88.55, P=.04) and tumor location in the upper thoracic esophagus (HR 3.48, 95% CI 1.02-11.85; P=.04) as independent predictors of local failure. A salvage endoscopic strategy applying APC for ycT1a and PDT for ycT1b-T2, with flexibility based on tumor depth, is feasible, safe, and effective. Tailoring treatment to invasion depth may optimize organ preservation and local control in residual or recurrent ESCC after CRT.

The objective of this review is to evaluate whether the presence and severity of the dysplastic margin predicts recurrence or survival outcomes in patients with primary oral squamous cell carcinoma (OSCC) resected with curative intent. There is variable evidence whether a dysplastic OSCC margin predicts worse recurrence or survival outcomes and, therefore, no consensus on whether a dysplastic margin should be regarded as an involved margin. Ambiguity of the prognostic significance of dysplasia in the resection margin means that management is institutionally dependent. This systematic review will include studies of patients with primary OSCC who have undergone surgery with curative intent, with or without adjuvant treatment. Studies will be included if they compare the recurrence and survival outcomes of dysplastic margins compared with clear, close, or involved margins. PubMed, Embase (Ovid), Web of Science Core Collection, Scopus, and gray literature will be searched. Two reviewers will independently undertake title/abstract and full-text screening. Included studies will be critically appraised using the QUIPS tool. Data extraction will use the CHARMS-PF checklist. Odds ratio, risk ratios, and hazard ratios along with standard errors, variances, or CIs will be extracted. Where possible, hazard ratios will be computed if not directly reported. Separate meta-analyses will be done for odds ratios, univariate hazard ratios, and multivariate hazard ratios. If meta-analysis is not possible, data will be synthesized narratively. The certainty of evidence will be assessed using the GRADE approach, and a Summary of Findings will be presented. PROSPERO CRD42024604073.

Introduction: Cutaneous squamous cell carcinoma (SCC) commonly affects sun-exposed areas, particularly the dorsum of the hand. However, palmar SCC is rare and can remain undiagnosed for a prolonged period. This case describes a unique instance of SCC originating from the palm with metastasis, initially misdiagnosed as primary breast cancer. Case Presentation: A 75-year-old woman, a retired agricultural laborer, presented with a chronic ulcerated mass on her right palm, with associated weight loss and regional nodal swellings. She had a traumatic palm injury treated with skin grafting 12 years prior. She previously underwent axillary and breast surgeries for lesions diagnosed as SCC, presumed to be of breast origin. Current examination revealed a 2.5 × 2 cm palmar mass and multiple nodal swellings. Biopsies confirmed well-differentiated SCC at all sites, and imaging showed no distant metastases but significant right-sided nodal involvement. The patient underwent wide local excision of the palm, modified radical mastectomy, and neck dissection, followed by split-thickness skin grafting. Recovery was uneventful. Clinical Discussion: Palmar SCC may arise from chronic inflammatory changes or trauma rather than UV exposure, as seen in this case. Misdiagnosis delayed appropriate treatment and allowed for significant nodal progression. SCC in atypical sites can be aggressive and necessitate early, multidisciplinary intervention. Conclusion: Palmar squamous cell carcinoma, although rare, must be considered in chronic non-healing hand ulcers, especially in patients with previous trauma or grafting. Thorough clinical correlation with histopathology, early biopsy, and prompt surgical management are essential to reduce morbidity from metastatic spread.

CO2 Transoral laser microsurgery (TLM) is a preferred technique for early-stage glottic lesions [1] (Yin et al Auris Nasus Larynx 50(3):415-422, 1), but reconstruction of the anterior commissure remains an unresolved issue. The anterior commissure is a surgically challenging area due to limited accessibility, high incidence of postoperative stenosis and risk of recurrence [2] (Chone et al Arch Otolaryngol Head Neck Surg 133(9):882-887, 2). To share our experience with a single-stage reconstruction technique for anterior commissure defects following TLM, using a buccal mucosal graft secured with sutures and tissue glue, and to present post-surgical outcomes. A series of five cases performed at VPS Lakeshore Hospital, Kochi, over a 1.5-year period (January 2024-April 2025) in patients with squamous cell carcinoma or carcinoma in situ of anterior commissure of glottis following TLM were evaluated. Written informed consent was obtained from all patients. TLM was performed using carbon dioxide laser, followed by reconstruction using a buccal mucosal graft fixed with polypropylene sutures and tissue glue. Outcomes were assessed using Voice Handicap Index (VHI) scores (Johnson et al Am J Speech-Language Pathol 6: 66-70, 3), video laryngoscopic evaluation of graft integrity, and rates of postoperative stenosis or adhesion. All patients remained free of disease at the end of the follow up period. VHI scores indicated acceptable postoperative voice quality. Post operative healing in patients who underwent transcutaneous suture fixation of grafts with tissue glue support demonstrated better and predictable outcomes in terms of stable graft positioning, good vocal cord approximation and minimal fibrosis. This novel, single-stage reconstruction technique allows good healing of anterior commissure defects by preventing stenosis. Functional outcomes measured by VHI are good. It offers a cost-effective alternative to staged procedures while ensuring optimal vocal outcomes.

The incidence trends of skin cancer are increasing across the world. However, data from Southeast Asian countries, including Thailand, are limited. Songkhla, a province in southern Thailand, has a predominant occupation and religion across different geographic areas which may influencing the incidence. This study aimed to assess the trends in skin cancer incidence in Songkhla according to age, calendar period, birth cohort, and geographical areas. The study included patients diagnosed with squamous cell carcinoma, basal cell carcinoma, and melanoma of the skin between 1989 and 2020, as recorded in the Songkhla population-based cancer registry. Geographic areas were classified into four categories with remaining groups: urban VS rural, Muslim VS Buddhist, fishing and farming VS other occupations, and rubber plantation VS other occupations. Age-standardized incidence rates (per 100,000 population) were calculated, and trend analyses were performed using Joinpoint regression and age-period-cohort analysis. The incidence of skin cancer in men declined after 2001 with annual percentage change rates of -2.24%, while it remained stable among women. However, when stratified by geographic area, the incidence among women showed a decline after 2016 in some areas. Overall, incidence rates were higher in urban than in rural areas, lower in predominantly Muslim than Buddhist areas, and lower in rubber plantation areas compared with other occupational areas. Age was positively associated with skin cancer incidence. The cohort effect demonstrated a decreasing rate ratio (RR) among men born after 1945, while no significant change in RR was observed among women. The period effect showed no significant influence on RR in either sex. Although the incidence of skin cancer in Songkhla, Thailand, has shown a decreasing trend in men and remained stable in women, awareness and prevention should continue to be emphasized, particularly among older individuals who are more prone to UV radiation exposure.

Impact of postoperative radiotherapy on combined local SCC events and survival in non-metastatic oral and pharyngeal squamous cell carcinoma.

Penile squamous cell carcinoma (PSCC) and its established precursor, penile intraepithelial neoplasia (PeIN), are classified as HPV-associated and HPV-independent. However, there is a spectrum of precursor lesions, which presents diagnostic challenges due to morphologic overlap. Immunohistochemical loss of GATA3, a tumor suppressor gene, has recently been reported in vulvar neoplasia. In this study, we evaluate the expression and diagnostic utility of GATA3 immunohistochemistry (IHC) in penile neoplasia. GATA3, p53, and p16 IHC was performed on 97 penile lesions, including lichen sclerosus (LS, N=14), condyloma acuminatum (N=11), squamous hyperplasia (SH, N=9), verrucous lesions (N=3), HPV-independent (N=12) and HPV-associated (N=18) PeIN, invasive HPV-independent, (N=19) and HPV-associated (N=11) PSCC, and normal skin (NL, N=41). GATA3 expression was scored as >75% basal/parabasal staining (pattern 0), 25% to 75% (pattern 1), 5% to 25% (pattern 2), and <5% (pattern 3). GATA3 was retained in NL (90%) and condyloma (73%) (P=0.15). LS and SH combined had significant GATA3 loss (44% pattern 0, 17% pattern 1, and 39% patterns 2 to 3) (P<0.001 vs. NL). HPV-independent PeIN had decreased GATA3 expression compared to NL (100% patterns 1 to 3, 87% patterns 2 to 3) (P<0.001), and LS-SH (P=0.003), but had similar expression to HPV-independent PSCC (P=1.00). HPV-associated PeIN and invasive PSCC had similar GATA3 loss (patterns 1 to 3, P=0.096). HPV-associated PSCC had a more severe loss (91%) than HPV-associated PeIN (39%) (P=0.008). These findings suggest that GATA3 alterations may be an early event during tumorigenesis, and that this marker may represent a useful complement to p16 and p53 in the differential diagnosis of HPV-independent PeIN from benign mimickers.

The mechanisms underlying resistance to neoadjuvant immunotherapy and chemoradiotherapy (nICRT) in locally advanced esophageal squamous cell carcinoma (ESCC) remain poorly understood. Through a single-arm phase II trial (n = 22) with 44.4-month median follow-up, we observed a significant survival disparity: patients achieving major pathologic response (MPR) exhibited superior 3-year event-free survival (EFS) and overall survival (OS), with no recurrence in MPR patients versus 71.4% recurrence in non-major pathological response (NMPR) patients (HR = 17.69, 95% CI 2.25-139.20, p = 0.0063). Integrating single-cell RNA/TCR sequencing and functional validation, we identified a PRDM1+ malignant cell subcluster enriched in NMPR patients and associated with treatment resistance. These cells exhibit strong lipid peroxidation characteristics, a state linked to the transcriptional activation of CTSB and MFSD12 mediated by PRDM1. This state renders the PRDM1+ malignant cell cluster more susceptible to ferroptosis induction. PRDM1+ cells further recruited immunosuppressive regulatory T cells (Tregs) through IL1A-IL1R2 interactions and activated lipid-metabolizing TREM2+ macrophages via CD47-SIRPA signaling, fostering an immune-evasive microenvironment. Conversely, MPR patients displayed expanded cytotoxic T-effector clones with enhanced tumor-killing capacity. Our findings identify PRDM1 as a key factor associated with nICRT resistance and suggest that targeting ferroptosis pathways or disrupting PRDM1+ cell-mediated immune suppression may represent a viable strategy in ESCC. Clinical trial registration number: NCT03940001.

Animal cancer registries (ACRs) are vital tools in veterinary oncology, offering insights into tumor epidemiology and supporting comparative research. Despite cancer being a major cause of feline mortality, data on feline tumor epidemiology remain limited. This study aimed to investigate temporal trends in histologically diagnosed feline tumors and assess how breed, sex, neuter status, age, and geographic origin affect malignancy and tumor distribution. A modified Vet-ICD-O-canine-1 coding system was applied to 5,289 tumors from two pathology-based ACRs in central Italy (2008-2023). Data were analyzed for time trends by the Cochrane-Armitage test, and logistic regression was used to assess the impact of the variables on tumor behavior ("malignant" vs. "benign") and the development of major cancer types. Of all tumors, 4,264 (80.6%) were malignant. Fibrosarcomas (n = 926; 17.5%), adenocarcinomas (n = 814; 15.4%), squamous cell carcinomas (SCCs; n = 738; 14.0%), and lymphomas (n = 507; 9.6%) were the most common types of cancer. Malignancy risk increased by 8% per year of age (OR = 1.08; 95%CI 1.06-1.10). Females (OR = 1.39; 95%CI 1.19-1.62) and non-purebred cats (OR = 1.89; 95%CI 1.47-2.38) had higher odds of malignancy. Neutered status was associated with reduced adenocarcinoma risk (OR = 0.79; 95% CI 0.66-0.94). Temporal trends included rising SCCs (p = 0.001) and declining fibrosarcomas (p < 0.001). These findings support previous findings and identify previously unknown risk factors, underscoring the value of multicenter ACR-based surveillance.

Surgical treatment can achieve a cure in stage IA non-small-cell lung cancer (NSCLC). Although invasion of vascular, lymphatic, or perineural structures does not alter TNM staging, such features are sometimes considered when recommending adjuvant therapy. This study aimed to evaluate the impact of these invasion types on overall survival (OS) and disease-free survival (DFS) in stage IA NSCLC patients who did not receive adjuvant treatment. A total of 402 patients with pathological stage T1N0M0 NSCLC who underwent anatomical lung resection between January 2014 and December 2019 were retrospectively analyzed. Final staging was performed according to the 8th edition of the TNM classification. Pathology reports and follow-up data were reviewed. Demographic features, surgical details, postoperative complications, and tumor invasion patterns were examined in relation to OS and DFS using Jamovi (v2.5.3.0). In multivariable analysis, older age (HR 1.03, 95% CI 1.00-1.06, p = 0.05), male sex (HR 1.81, 95% CI 1.10-2.98, p = 0.01), and postoperative complications (HR 1.64, 95% CI 1.12-2.40, p = 0.01) independently predicted lower OS. While individual invasion types were not significantly associated with OS, their co-occurrence predicted poorer OS (HR 4.06, p = 0.05) and DFS (HR 12.74, p = 0.001). In subgroup analyses, lymphatic invasion was linked to reduced OS in male patients (HR 1.46, p = 0.04), while lymphatic and vascular invasion both negatively affected OS in squamous cell carcinoma (HR 1.72 and 1.98, respectively). When all three invasion types were present, prognosis worsened markedly in stage IA NSCLC. Sex- and histology-based risk assessment may help guide postoperative treatment decisions.

Background To evaluate the utility of restricted spectrum imaging (RSI) for predicting subtypes of non-small cell lung cancer (NSCLC). Methods A total of 97 patients with NSCLC (30 with squamous cell carcinoma (SCC) and 67 with adenocarcinoma (AC)) were included. The parameters f 1 , f 2 , f 3 , apparent diffusion coefficient (ADC), and maximum standardized uptake value (SUV max ) were measured and compared between the two subtypes. Logistic regression analysis was used to identify independent predictors, and a combined diagnostic model was developed. The performance of the model was assessed using receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis (DCA). Results Compared with the AC group, the SCC group exhibited significantly higher SUV max , f 2 , and f 3 values, and lower ADC and f 1 values (all P &amp;lt; 0.05). Smoking status, f 1 , SUV max , and ADC were independent predictors of NSCLC subtypes. The combined model demonstrated superior diagnostic accuracy (AUC = 0.909; sensitivity = 73.33%; specificity = 89.55%) compared with individual predictors (AUC = 0.693, 0.819, 0.767, and 0.742 for smoking status, f 1 , SUV max , and ADC, respectively; all P &amp;lt; 0.01). Bootstrap resampling (1000 samples) validated the robustness of the model (AUC = 0.895). Calibration curves and DCA confirmed the model’s stability and clinical utility. Conclusion RSI can effectively differentiate NSCLC subtypes.

Resistance to chemotherapy drugs is one of the significant factors for limited treatment options and poor prognosis in esophageal cancer. A study has found that SOX12 plays a role in cisplatin resistance in hepatocellular carcinoma cells, but the function and mechanism of SOX12 in cisplatin resistance in esophageal cancer are unclear. Our study found that SOX12 protein levels are significantly elevated in cisplatin-resistant esophageal cancer cell lines and in esophageal cancer cells treated with cisplatin. Knocking down SOX12 enhances the sensitivity of esophageal cancer cells to cisplatin. Additionally, we have observed that elevated SOX12 protein promotes the efficiency of DNA double-strand break repair. Mechanistically, we found that the depletion of SOX12 results in a notable reduction in the levels of RNF168 protein, while its mRNA expression remains unaffected. Furthermore, we demonstrated that SOX12 regulates RNF168 protein stability by transcriptionally repressing the expression of TRIP12 and UBR5. On the other hand, we have also discovered that RNF168 interacts with and stabilizes SOX12 protein via a ubiquitin-proteasome system. Collectively, our study identifies a feedback regulatory loop between SOX12 and RNF168 that promotes DNA damage repair and cisplatin resistance in esophageal cancer cells.

High-Risk Cutaneous Squamous Cell Carcinoma: A Review of Current Evidence and Emerging Standards.

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). We analyzed 422 consecutive LAOSCC patients treated at a single institute between 2007 and 2017. The MDR was defined as the ratio of the closest surgical margin (mm) to tumor depth of invasion (DOI, 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. The optimal MDR cutoff for predicting survival was 0.35. Patients with MDR ≥ 0.35 (high MDR, n = 205) demonstrated significantly better 5-year OS (66.1% vs. 47.6%, p < 0.001), CSS (77.5% vs. 57.4%, p < 0.001), and RFS (71.5% vs. 53.8%, p = 0.001) compared with those with MDR < 0.35 (low MDR, n = 217). In multivariate analysis, low MDR remained an independent adverse prognostic factor for OS (HR = 1.61, p = 0.005), CSS (HR = 2.05, p = 0.001) and RFS (HR = 1.50, p = 0.033). Among patients with adequate margins (≥5 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. 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.