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Priority of Adjuvant Radiation Therapy in Patients with Oral Cavity Cancer and Close Margins? Impact of Invasive Tumor Depth

摘要


Background and Purpose: The quality of resection margins is considered an important predictor of treatment outcomes in patients with oral cavity squamous cell carcinoma (OSCC). However, the NCCN guidelines do not thoroughly address the impact of pathological margin status on local control. The aims of this study were (1) to investigate whether close margins (< 5 mm) may affect treatment outcomes in resected OSCC patients, and (2) to identify the risk factors associated with close margins. Material and Methods: Between January 1996 and November 2011, we enrolled a total of 1,609 patients who underwent radical surgery for OSCC (either with or without neck dissection). The 5-year survival rates served as the main outcome measure. Results: Among 1,586 OSCC patients, 1,437 (90.6%) had pathologically clear margins ≥ 5 mm, whereas 149 (9.4%) showed close margins < 5 mm. Twenty-three patients with unknown/positive margins were excluded. Compared with patients with close margins, those with clear margins had better 5-year local control, lower distant metastatic, better disease-free survival (DFS), better disease-specific survival (DSS), and better overall survival (OS) rates. In the subgroup of patients with close margins, those with tumor depth < 10 mm showed better 5-year local control, DFS, DSS, and OS rates than subjects with a depth ≥ 10 mm. Conclusions: We conclude that resected OSCC patients with close margins (< 5 mm) are characterized by poor outcomes. The use of adjuvant therapy may be considered for patients with close margins, especially in the presence of tumor depth ≥ 10 mm.

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