12.08.2016 | Head and Neck Oncology | Ausgabe 6/2017
Differential Impact of Close Surgical Margin on Local Recurrence According to Primary Tumor Size in Oral Squamous Cell Carcinoma
- Zeitschrift:
- Annals of Surgical Oncology > Ausgabe 6/2017
Wichtige Hinweise
Electronic supplementary material
The online version of this article (doi:10.1245/s10434-016-5497-4) contains supplementary material, which is available to authorized users.
Jeon Yeob Jang, Nayeon Choi, Kwan-Hyuck Baek and Han-Sin Jeong have contributed equally to this article.
Abstract
Background
The extent of surgical safety margin (gross tumor border to resection margin) in oral cancer surgery remains unclear, and no study has determined the differential impact of close surgical margin and microscopic extension according to primary tumor size in oral cancers.
Methods
We retrospectively analyzed the clinical data of 325 patients with surgically treated oral cavity squamous cell carcinomas to determine the effect of a close surgical margin (<5 mm) (cSM5) on local recurrence. In addition, the depth of microscopic tumor infiltration was determined in 90 available surgical specimens.
Results
The cSM5 was not related to the risk of local tumor recurrence in early-stage oral cancer, while it significantly increased the rate of local tumor recurrence in resectable advanced-stage oral cancers (hazard ratio 3.157, 95 % confidence interval 1.050–9.407, p = 0.041). Addition of postoperative adjuvant radiation to early-stage tumors with cSM5 did not further reduce the local recurrence rate compared to surgery alone. The depth of microscopic tumor extension from the gross tumor border was significantly associated with primary tumor thickness (ρ = 0.390, p < 0.001) and tumor sizes (ρ = 0.308, p = 0.003), which was a median (range) of 0.84 (0.14–2.32) mm in T1, 1.06 (0.20–4.34) mm in T2, and 1.77 (0.13–4.70) mm in T3–4.
Conclusions
The cSM5 was a significant risk factor for local recurrence only in advanced oral cancers, but not in early-stage tumors, where microscopic tumor extension was not beyond 3 mm in T1 tumors. Thus, the extent of surgical safety margin can be redefined according to the primary tumor size.
