Positive margins matter regardless of subsequent resection findings

Brendan Coutu; Evan Ryan; Dallin Christensen; Elliot Lawrence; Elizabeth Bradford Bell; Weining Zhen; Zafar Sayed

doi:10.1016/j.oraloncology.2022.105850

Positive margins matter regardless of subsequent resection findings

Oral Oncol. 2022 May:128:105850. doi: 10.1016/j.oraloncology.2022.105850. Epub 2022 Apr 15.

Authors

Brendan Coutu¹, Evan Ryan², Dallin Christensen², Elliot Lawrence¹, Elizabeth Bradford Bell², Weining Zhen¹, Zafar Sayed³

Affiliations

¹ Department of Radiation Oncology, University of Nebraska Medical Center, 986861 Nebraska Medical Center, Omaha, NE 68198-6861, United States.
² Department of Otolaryngology, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha Nebraska 68198-1225, United States.
³ Department of Otolaryngology, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha Nebraska 68198-1225, United States. Electronic address: zafar.sayed@unmc.edu.

PMID: 35436713
DOI: 10.1016/j.oraloncology.2022.105850

Abstract

Objectives: In the resection of oral cavity squamous cell carcinoma (OCSCC), an intraoperative positive surgical margin (SM) communicated to the head and neck surgeon necessitates further resection of the area of identified involvement to achieve a final negative SM. The prognostic implication of initial positive SM when the final SM is negative is understudied.

Materials and methods: We retrospectively reviewed 249 patients with non-metastatic (stage I-IVB) OCSCC who underwent a resection from 2010 to 2019 to assess the prognostic impact of an initial positive SM. Chi-squared analysis was used to evaluate the association between an initial positive SM and clinicopathologic parameters. A Kaplan-Meier analysis was performed to estimate patient outcomes with Cox regression analysis used to determine absolute hazards.

Results: At a median follow-up of 28.4 months, the 2-year freedom from local recurrence (FFLR), disease-free survival (DFS), and overall survival (OS) rates were 82.1%, 63.5%, and 78.5%, respectively. Fifty patients (20.1%) had an initial positive SM which was revised to a negative SM on frozen and permanent sections by resecting further tissue while 12 patients (4.8%) had a final positive SM. An initial positive SM was independently associated with a worse FFLR (HR: 2.696, p = 0.004), DFS (HR: 1.57, p = 0.044), and OS (HR: 1.72, p = 0.029).

Conclusion: An initial positive SM is independently associated with worse disease control and patient survival. A positive SM may be a surrogate for diffusely infiltrative disease as further malignancy identified on the re-resection specimen was associated with worse outcomes.

Keywords: Adjuvant management; Head and neck; Margin; Oral cavity squamous cell carcinoma.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Head and Neck Neoplasms*
Humans
Margins of Excision
Mouth Neoplasms* / pathology
Neoplasm Recurrence, Local / pathology
Prognosis
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck / surgery