Bayesian Monte Carlo Simulation Based on Systematic Review for Personalized Risk Stratification of Contralateral
Karthik N Rao1, M P Sreeram1, Prajwal Dange1
1Department of Head and Neck Oncology, Sri Shankara Cancer Foundation, Bangalore 560004, India.
Diagnostics (Basel, Switzerland)
|November 13, 2025
Summary
Contralateral lymph node metastasis (CLNM) risk in oral squamous cell carcinoma (OSCC) can be estimated using Bayesian Monte Carlo Simulation. This model helps stratify patients for tailored neck dissection, improving surgical planning.
Area of Science:
- Oncology
- Head and Neck Surgery
- Biostatistics
Background:
- Contralateral lymph node metastasis (CLNM) in oral squamous cell carcinoma (OSCC) poses a significant clinical challenge for node-negative neck patients.
- Accurate risk stratification is essential for guiding decisions on elective contralateral neck dissection.
- Existing models often lack precision in predicting CLNM across diverse patient profiles.
Purpose of the Study:
- To develop a robust model for estimating CLNM probability in OSCC.
- To integrate key clinic-pathological risk factors into a Bayesian framework.
- To provide data-driven insights for individualized surgical management.
Main Methods:
- Systematic literature review of 26 studies (PubMed, Embase, 2000-2024).
- Bayesian logistic regression incorporating seven risk factors: midline crossing, extranodal extension (ENE), ipsilateral nodes, depth of invasion (DOI), perineural/lymphovascular invasion (PNI-LVI), differentiation, and subsite.
- Bayesian Monte Carlo Simulation (MCS) using No-U-Turn Sampler (NUTS) with 100,000 virtual patients.
Main Results:
- Baseline CLNM risk for lateralized tumors without risk factors is 4.2%.
- Single risk factors significantly increase CLNM probability (e.g., midline crossing: 31.7%, ENE: 27.4%).
- Combinations of risk factors amplify risk non-linearly, reaching 93.7% with all seven factors. Risk tiers (minimal to very high) were established.
Conclusions:
- CLNM risk escalates multiplicatively with the presence of high-risk features in OSCC.
- The developed MCS model supports bilateral neck management for high-risk patients and observation for low-risk cases.
- Prospective validation is recommended for clinical integration and patient-specific surgical planning.
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