Adequate surgical margins for oral cancer: A Taiwan cancer registry national database analysis

Mei-Chun Lin; Yi-Shing Leu; Chun-Ju Chiang; Jenq-Yuh Ko; Cheng-Ping Wang; Tsung-Lin Yang; Tseng-Cheng Chen; Chun-Nan Chen; Hsin-Lin Chen; Chun-Ta Liao; Sen-Tien Tsai; Jin-Ching Lin; Pen-Yuan Chu; Kuo-Yang Tsai; Ming-Hsui Tsai; Huai-Cheng Huang; Muh-Hwa Yang; Yuan-Hua Wu; Shyuang-Der Terng; Chih-Yen Chien; Tsang-Wu Liu; Wen-Chung Lee; Pei-Jen Lou

doi:10.1016/j.oraloncology.2021.105358

Adequate surgical margins for oral cancer: A Taiwan cancer registry national database analysis

Oral Oncol. 2021 Aug:119:105358. doi: 10.1016/j.oraloncology.2021.105358. Epub 2021 May 26.

Authors

Mei-Chun Lin¹, Yi-Shing Leu², Chun-Ju Chiang³, Jenq-Yuh Ko⁴, Cheng-Ping Wang⁴, Tsung-Lin Yang⁴, Tseng-Cheng Chen⁴, Chun-Nan Chen⁴, Hsin-Lin Chen⁵, Chun-Ta Liao⁶, Sen-Tien Tsai⁷, Jin-Ching Lin⁸, Pen-Yuan Chu⁹, Kuo-Yang Tsai¹⁰, Ming-Hsui Tsai¹¹, Huai-Cheng Huang¹², Muh-Hwa Yang¹³, Yuan-Hua Wu¹⁴, Shyuang-Der Terng¹⁵, Chih-Yen Chien¹⁶, Tsang-Wu Liu¹⁷, Wen-Chung Lee³, Pei-Jen Lou¹⁸

Affiliations

¹ Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
² Department of Otolaryngology, MacKay Memorial Hospital, Taipei, Taiwan.
³ Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan.
⁴ Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Department of Otolaryngology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
⁶ Departments of Otolaryncology-Head and Neck Surgery, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.
⁷ Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁹ Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, Changhua, Taiwan.
¹¹ Department of Otorhinolaryngology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
¹² Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
¹³ Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Infection and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan.
¹⁴ Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan Taiwan.
¹⁵ Koo Foundation Sun Yat-Sen Cancer Center, Taiwan.
¹⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹⁷ National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan.
¹⁸ Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: pjlou@ntu.edu.tw.

PMID: 34049257
DOI: 10.1016/j.oraloncology.2021.105358

Abstract

Background: Margin status and lymph node metastasis are the most important prognostic factors for oral cancers. However, while adequate surgical resection is crucial for local control and prognosis, the definition of clear margins has long been a subject of debate. In this study, we analyzed data from a nationwide population-based cancer registry database and evaluated the impact of surgical margins on cancer-specific survival (CSS) and overall survival (OS) as well as the optimal cutoff of adequate surgical margins.

Methods: This analysis included all cases of oral cancer diagnosed from 2011 to 2017 that were reported to the Taiwan Cancer Registry database. The staging system was converted from American Joint Committee on Cancer (AJCC) version 7 to AJCC version 8. Kaplan-Meier analysis and Cox proportional-hazards regression were performed to identify covariates that were significantly associated with CSS and OS.

Results: Between 2011 and 2017, 15,654 of a total of 36,091 cases diagnosed with oral cancers were included in the final analyses. Advanced N stage, positive margins, and advanced T stage are the leading risk factors for poor CSS and OS. When surgical margins were subdivided into 1-mm intervals from 5 mm to positive margin, we found that surgical margins <4 mm and <5 mm predict poor CSS and OS, respectively.

Conclusions: This is the first nationwide, population-based cohort to revisit the question of the adequate surgical margins for oral cancers. We conclude that surgical margins ≥4 mm and ≥5 mm are adequate for good CSS and OS, respectively.

Keywords: American Joint Committee on Cancer (AJCC) eighth edition; Oral cancer; Squamous cell carcinoma; Surgical margin; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Margins of Excision*
Mouth Neoplasms* / epidemiology
Mouth Neoplasms* / pathology
Mouth Neoplasms* / surgery
Neoplasm Staging
Prognosis
Proportional Hazards Models
Registries
Retrospective Studies
Taiwan / epidemiology