Mandeep S Bajwa1, David Houghton2, Kapil Java3, Asterios Triantafyllou4, Owais Khattak3, Fazilet Bekiroglu5, Andrew G Schache6, James S Brown7, James A McCaul8, Simon N Rogers9, Derek Lowe10, Jeremy McMahon11, Richard J Shaw12. 1. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. Electronic address: msbajwa@liverpool.ac.uk. 2. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK. Electronic address: drhoughton@doctors.org.uk. 3. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK. 4. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Oral Pathology, School of Dentistry, University of Liverpool, Liverpool, UK. Electronic address: triantaf@liverpool.ac.uk. 5. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK. Electronic address: fbekiroglu@doctors.org.uk. 6. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. Electronic address: schache@liverpool.ac.uk. 7. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. Electronic address: brownjs@doctors.org.uk. 8. Department of Oral & Maxillofacial Surgery, NHS Greater Glasgow & Clyde, Glasgow, UK. 9. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Edge Hill University, Ormskirk, UK. Electronic address: snrogers62@icloud.com. 10. Astraglobe Ltd, Congleton, Cheshire, UK. Electronic address: astraglobeltd@btconnect.com. 11. Department of Oral & Maxillofacial Surgery, NHS Greater Glasgow & Clyde, Glasgow, UK. Electronic address: jeremymcmahon@nhs.net. 12. Liverpool Head & Neck Centre, Aintree University Hospital, Liverpool, UK; Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. Electronic address: rjshaw@liverpool.ac.uk.
Abstract
OBJECTIVES: There is controversy regarding surgical margins in the management of early oral squamous cell carcinoma (OSCC). The main objectives of this study were to assess the: relevance of the margin independent of tumour variables; threshold for a safe margin; relevance of dysplasia at the margin. MATERIALS & METHODS: UK based retrospective multicenter cohort study of patients with previously untreated and clinically early OSCC between 1998 and 2016. All patients had surgery as the primary modality and had surgical staging of the neck. Minimum follow-up was 2 years. Margins were classified as: clear ≥5.0 mm; close 1.0-4.9 mm; involved not cut-through (INC-T) 0.1-0.9 mm; cut-through (C-T) 0 mm. RESULTS: 669 patients were included. After adjusting for tumour variables Cox multivariate regression analysis demonstrated that close margins had similar survival outcomes to clear margins (Hazard Ratio(HR) 0.99 (95%CI 0.50-1.95) for Local Recurrence Free Survival (LRFS); HR 1.08 (95%CI 0.7-1.66) for Disease Free Survival (DFS); HR 0.74 (95%CI 0.44-1.25) for Disease Specific Survival (DSS); HR 0.80 (95%CI 0.58-1.11) for Overall Survival (OS)). C-T margins had significantly worse LRFS (HR 5.01 (95%CI 2.02-12.39)) and DFS (HR 2.58 (95%CI 1.28-5.20)). INC-T margins had significantly worse DFS (HR 1.98 (95% CI 1.01-3.87)). Time dependent receiver operating characteristic curve analysis did not demonstrate a clear margin threshold for LRFS within 24 months (AUC = 0.53 (95%CI 0.41-0.64)). Dysplasia at the margin did not influence LRFS or DFS. CONCLUSION: Only resection margins <1 mm independently affected survival outcomes. This should be considered when making decisions regarding adjuvant treatment. Crown
OBJECTIVES: There is controversy regarding surgical margins in the management of early oral squamous cell carcinoma (OSCC). The main objectives of this study were to assess the: relevance of the margin independent of tumour variables; threshold for a safe margin; relevance of dysplasia at the margin. MATERIALS & METHODS: UK based retrospective multicenter cohort study of patients with previously untreated and clinically early OSCC between 1998 and 2016. All patients had surgery as the primary modality and had surgical staging of the neck. Minimum follow-up was 2 years. Margins were classified as: clear ≥5.0 mm; close 1.0-4.9 mm; involved not cut-through (INC-T) 0.1-0.9 mm; cut-through (C-T) 0 mm. RESULTS: 669 patients were included. After adjusting for tumour variables Cox multivariate regression analysis demonstrated that close margins had similar survival outcomes to clear margins (Hazard Ratio(HR) 0.99 (95%CI 0.50-1.95) for Local Recurrence Free Survival (LRFS); HR 1.08 (95%CI 0.7-1.66) for Disease Free Survival (DFS); HR 0.74 (95%CI 0.44-1.25) for Disease Specific Survival (DSS); HR 0.80 (95%CI 0.58-1.11) for Overall Survival (OS)). C-T margins had significantly worse LRFS (HR 5.01 (95%CI 2.02-12.39)) and DFS (HR 2.58 (95%CI 1.28-5.20)). INC-T margins had significantly worse DFS (HR 1.98 (95% CI 1.01-3.87)). Time dependent receiver operating characteristic curve analysis did not demonstrate a clear margin threshold for LRFS within 24 months (AUC = 0.53 (95%CI 0.41-0.64)). Dysplasia at the margin did not influence LRFS or DFS. CONCLUSION: Only resection margins <1 mm independently affected survival outcomes. This should be considered when making decisions regarding adjuvant treatment. Crown
Authors: James Fowler; Yael Campanile; Andrew Warner; Francisco Laxague; Naif Fnais; Kevin Fung; Adrian Mendez; Danielle MacNeil; John Yoo; David Palma; Anthony Nichols Journal: J Otolaryngol Head Neck Surg Date: 2022-10-04