Abstract
Simple SummaryWhile the prognostic role of surgical margins in oral cavity squamous cell carcinoma is well-established, the optimal cutoff values for margin status remain controversial. This study addressed this issue in a large sample of 13,768 patients included in a nationwide registry in Taiwan. The identification of the most suitable cutoff value for surgical margins was conducted using 5-year local control as the outcome of interest. On analyzing the margin status—categorized as 0, 0.1–4 and > 4 mm—the 5-year outcomes were as follows: local control, 87, 89 and 92%; disease-specific survival, 57, 76 and 81%; overall survival, 47, 67 and 74%, respectively. Collectively, these data indicate that a margin status >4 mm can be considered as adequate.(1) Background: The optimal cutoff value that maximizes the prognostic value of surgical margins in patients with resected oral cavity squamous cell carcinoma has not yet been identified. (2) Methods: Data for this study were retrieved from the Taiwan Cancer Registry Database. A total of 13,768 Taiwanese patients with oral cavity squamous cell carcinoma were identified and stratified according to different margin statuses (0, 0.1–4 and > 4 mm). The five-year local control, disease-specific survival and overall survival rates were the main outcome measures. (3) Results: The 5-year local control, disease-specific survival and overall survival rates of patients with close margins (0 and 0.1–4 mm) were significantly lower than those observed in patients with clear margins (> 4 mm; all p values < 0.001). In multivariate analysis, margin status, depth of invasion and extra-nodal extension were identified as independent adverse prognostic factors for 5-year local control. (4) Conclusions: A thorough assessment of surgical margins can provide a reliable prognostic prediction in patients with OCSCC. This has potential implications for treatment approaches tailored to the individual level. The achievement of clear margins (>4 mm) should be considered a key surgical goal to improve outcomes in this patient group.
Highlights
With only 5% of oral malignancies being other types, the most common form of oral cancer is oral cavity squamous cell carcinoma (OCSCC)
While surgical excision remains the mainstay of therapy, several studies have reported that post-operative adjuvant concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone may improve prognosis in patients with OCSCC [1,2]
Thereafter, Chen et al [5] proposed a cutoff of 5 mm for clear surgical margins—which is in line with the current NCCN guidelines
Summary
With only 5% of oral malignancies being other types, the most common form of oral cancer is oral cavity squamous cell carcinoma (OCSCC). Estimates derived from epidemiological data have shown that the incidence rates of OCSCC are rapidly increasing worldwide. A suboptimal tumor resection with an inadequate tumor resection margin portends adverse outcomes, including reduced survival and an increased risk of recurrences. The NCCN guidelines (version: February 2021) for head and neck malignancies maintain that a surgical margin should be considered clear when the distance from the tumor invasion front is ≥ 5 mm [3]. The association between positive margins and poor outcomes in OCSCC was described for the first time in 1978 [4]. Thereafter, Chen et al [5] proposed a cutoff of 5 mm for clear surgical margins—which is in line with the current NCCN guidelines
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