Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status

Molony, Peter; Kharytaniuk, Natallia; Boyle, Seamus; Woods, Robbie; O’Leary, Gerard; Werner, Réiltín; Heffron, Cynthia; Feeley, Linda; Sheahan, Patrick

doi:10.1002/hed.24824

Cited by 42 publications

(38 citation statements)

References 24 publications

(51 reference statements)

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“…Although these patients are more likely to receive RT and/or CT, we found that positive surgical margins were independently associated with decreased OS for all subsites, reinforcing the importance of complete surgical extirpation. This has been replicated at many other head and neck sites . The patient and tumor factors found here can be used to identify patients at high risk of positive margins, and these patients should be referred to high‐volume facilities in order to maximize the chance of achieving negative margins and, accordingly, their OS.…”

Section: Discussionmentioning

confidence: 71%

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Torabi

Spock²,

Cardoso

et al. 2019

The Laryngoscope

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Objectives: To identify factors associated with positive margins following surgical management of sinonasal squamous cell carcinoma (SNSCC), especially with regard to endoscopic treatment.Methods: In a retrospective analysis of adult patients with clinically staged tumor (T)1 to T4a SNSCC within the National Cancer Database (NCDB) from 2004 to 2014, factors were associated with positive margins using multivariable binary logistic regression. Cases from 2010 to 2014 had surgical approach (open vs. endoscopic) available and were analyzed in a subgroup to assess the association of surgical approach with margin status. The association of margin status with overall survival (OS) and additional therapy administration was also assessed.Results: We identified 2,968 cases, of which 807 (27.2%) had positive margins. On multivariable analysis, factors associated with positive margins included higher T stage (T4a vs. T1: odds ratio [OR] 2.768 [95% CI 2.143-3.577]), less differentiated tumors (poorly differentiated vs. well differentiated: OR 1.403 [95% CI 1.060-1.856]), and tumors in the ethmoid sinus (vs. nasal cavity; OR 1.889 [95% CI 1.305-2.734]). Cases treated at higher volume facilities (HVFs) were associated with a lower likelihood of positive margins (OR 0.716 [95% CI 0.582-0.881]). Positive margins were associated with decreased OS (hazard ratio 1.672 [95% CI 1.464-1.908]) and an increased rate of additional therapy (OR 1.966 [95% confidence interval 1.597-2.421]). An endoscopic approach was not associated with an increased likelihood of obtaining positive margins (vs. open; OR 1.151 [0.903-1.651]).Conclusion: Positive margins were less likely when performed at HVFs and more likely in the ethmoid sinus than other subsites. Importantly, there was no association between positive margins and surgical approach. Endoscopic surgery may offer a safe, less invasive alternative to open surgery for select patients.

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Section: Discussionmentioning

confidence: 71%

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Torabi

Spock²,

Cardoso

et al. 2019

The Laryngoscope

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“…The overall positive margin rate of 31% identified here is consistent with other studies on parotid tumors, but markedly higher than with most other types of HNC. 16,[25][26][27][28][29][30][31] The parotid gland is near multiple critical structures, particularly the facial nerve; therefore, wide resection margins may be deprioritized to reduce surgical morbidity. 10 Advanced T stage was associated with positive margins, with 50% of T4A tumors with positive margins compared to 18% of T1.…”

Section: Discussionmentioning

confidence: 99%

Positive surgical margins in parotid malignancies: Institutional variation and survival association

et al. 2018

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“…A similar thought process has recently been examined with regard to breast cancer for focally positive margins . Within the head and neck, the necessity for addition of chemotherapy in the presence of positive margins has also been questioned for p16‐positive oropharyngeal cancer . At present, however, this rationale does not seem to have been explored in a systematic manner for other disease sites within the head and neck.…”

Section: Discussionmentioning

confidence: 99%

Patterns of care and outcomes of adjuvant therapy for high‐risk head and neck cancer after surgery

et al. 2018

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Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status

Abstract: Patients with p16-positive oropharyngeal SCC and positive margins after excision maintain a low risk of recurrence despite most receiving RT alone as adjuvant treatment. These findings raise questions regarding the additional benefit of postoperative CRT in this group.

Cited by 42 publications

References 24 publications

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Positive surgical margins in parotid malignancies: Institutional variation and survival association

Patterns of care and outcomes of adjuvant therapy for high‐risk head and neck cancer after surgery

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