Mitsunobu Otsuru1, Takumi Hasegawa2, Nobuhiro Yamakawa3, Masaya Okura4,5, Shin-Ichi Yamada6, Eiji Hirai7, Toru Inomata8, Hirokazu Saito9, Kei-Ichiro Miura10, Kohei Furukawa11, Tomofumi Naruse11, Souichi Yanamoto12, Masahiro Umeda11. 1. Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. ootsuru@nagasaki-u.ac.jp. 2. Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 3. Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Kashihara, Japan. 4. The First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan. 5. Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, Matsusaka, Japan. 6. Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan. 7. Department of Oral and Maxillofacial Surgery, Oita Red Cross Hospital, Oita, Japan. 8. Department of Oral and Maxillofacial Surgery, Nippon Dental University, Hospital, Tokyo, Japan. 9. Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan. 10. Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, Miyagi, Sendai, Japan. 11. Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 12. Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Abstract
BACKGROUND: Pathological close margins are considered a significant factor for local recurrence in patients with oral cancer. However, the oral cavity has complicated anatomical features, and the appropriate margin distance for each site is unknown. This multicenter, retrospective study aimed to determine the appropriate resection margin for early tongue cancer and investigate the need for additional treatment for close margins and stump dysplasia. PATIENTS AND METHODS: In total, 564 patients from ten hospitals were enrolled in this study. Sex, age, performance status, T stage, tumor length diameter, depth of invasion, elective neck dissection, iodine staining, horizontal margin distance, vertical margin distance, pathological differentiation, invasion pattern, lymphatic invasion, perineural invasion, dysplasia in the resection edge, additional treatment for close margins, local recurrence, neck metastasis, distant metastasis, and outcomes were investigated. RESULTS: Receiver operating characteristic analysis for local recurrence revealed cut-off values of 3.3 mm for horizontal distance and 3.1 mm for vertical distance. Patients with close horizontal or vertical margins showed significantly higher local recurrence rates, but these were not associated with overall or disease-specific survival. Furthermore, there was no effect of additional treatment in patients with dysplasia at the surgical margin. CONCLUSION: For early tongue cancer, a horizontal margin of 3.3 mm was defined as a close margin. Close margins were significantly correlated with local recurrence but did not affect survival. In the future, we would like to examine the concept of "quality margins," including the surrounding anatomical features.
BACKGROUND: Pathological close margins are considered a significant factor for local recurrence in patients with oral cancer. However, the oral cavity has complicated anatomical features, and the appropriate margin distance for each site is unknown. This multicenter, retrospective study aimed to determine the appropriate resection margin for early tongue cancer and investigate the need for additional treatment for close margins and stump dysplasia. PATIENTS AND METHODS: In total, 564 patients from ten hospitals were enrolled in this study. Sex, age, performance status, T stage, tumor length diameter, depth of invasion, elective neck dissection, iodine staining, horizontal margin distance, vertical margin distance, pathological differentiation, invasion pattern, lymphatic invasion, perineural invasion, dysplasia in the resection edge, additional treatment for close margins, local recurrence, neck metastasis, distant metastasis, and outcomes were investigated. RESULTS: Receiver operating characteristic analysis for local recurrence revealed cut-off values of 3.3 mm for horizontal distance and 3.1 mm for vertical distance. Patients with close horizontal or vertical margins showed significantly higher local recurrence rates, but these were not associated with overall or disease-specific survival. Furthermore, there was no effect of additional treatment in patients with dysplasia at the surgical margin. CONCLUSION: For early tongue cancer, a horizontal margin of 3.3 mm was defined as a close margin. Close margins were significantly correlated with local recurrence but did not affect survival. In the future, we would like to examine the concept of "quality margins," including the surrounding anatomical features.