Independent Predictors of Prognosis Based on Oral Cavity Squamous Cell Carcinoma Surgical Margins

Abstract

Objective To conduct a multivariate analysis of a large cohort of oral cavity squamous cell carcinoma (OCSCC) cases for independent predictors of local recurrence (LR) and overall survival (OS), with emphasis on the relationship between (1) prognosis and (2) main specimen permanent margins and intraoperative tumor bed frozen margins. Study Design Retrospective cohort study. Setting Tertiary academic head and neck cancer program. Subjects and Methods This study included 426 patients treated with OCSCC resection between 2005 and 2014 at University of Iowa Hospitals and Clinics. Patients underwent excision of OCSCC with intraoperative tumor bed frozen margin sampling and main specimen permanent margin assessment. Multivariate analysis of the data set to predict LR and OS was performed. Results Independent predictors of LR included nodal involvement, histologic grade, and main specimen permanent margin status. Specifically, the presence of a positive margin (odds ratio, 6.21; 95% CI, 3.3-11.9) or <1-mm/carcinoma in situ margin (odds ratio, 2.41; 95% CI, 1.19-4.87) on the main specimen was an independent predictor of LR, whereas intraoperative tumor bed margins were not predictive of LR on multivariate analysis. Similarly, independent predictors of OS on multivariate analysis included nodal involvement, extracapsular extension, and a positive main specimen margin. Tumor bed margins did not independently predict OS. Conclusion The main specimen margin is a strong independent predictor of LR and OS on multivariate analysis. Intraoperative tumor bed frozen margins do not independently predict prognosis. We conclude that emphasis should be placed on evaluating the main specimen margins when estimating prognosis after OCSCC resection.

Staging more important than grading? Evaluation of malignancy grading, depth of invasion, and resection margins in oral squamous cell carcinoma

“…To address these issues, also two staging parameters, DOI and RM, which can be assessed during pathohistological examination of HE-slides, were evaluated separately. In concordance with other publications [43,47,48] resection margin could not be identified as a significant predictor of survival or LM, even when summarizing patients into subgroups (RM ≤ 1 mm, ≤ 5 mm, > 5 mm) according to values previously published as significant prognostic indicators [26,27]. These findings can possibly be explained with complete (R0) tumor resection being achieved in all patients of this collective and because mean RM was 6.0 mm and the number of patients with involved (RM ≤ 1 mm) margins was only 5.…”

“…Resection margin (RM) on the other hand could not be identified as a significant predictor of OS or RFS. Patients were then summarized into subgroups (RM ≤ 1 mm, 1 mm < RM ≤ 5 mm, > 5 mm) according to values previously published as significant prognostic indicators [26,27], also yielding no significant result.…”

Specimen‐driven intraoperative assessment of resection margins should be standard of care for oral cancer patients

“…Two methods of IOARM can be distinguished: the traditional defect-driven IOARM based on frozen sections and the recently recommended specimen-driven assessment. Although the frozen section analysis is a well-known procedure available in many centers, studies have reported that it has no impact on regional control or an improvement in survival in OCSCC patients (Abbas, Ikram, Tariq, Raheem, & Saeed, 2017;Buchakjian et al, 2018;Buchakjian, Tasche, Robinson, Pagedar, & Sperry, 2016;Mair et al, 2017;Pathak et al, 2009;Varvares et al, 2015).…”

Patients with revised surgical resection margins are best studied as a distinct group

“…In other reports, the main resection specimen alone defines the margin status and its prognostic value is not modified by re-excisions. 3,4 The College of American Pathologists offers some guidelines for Cancer November 1, 2018 margins revised into negative margins? In a randomized, single-blind, controlled trial, we recently compared 2 common methods of intraoperative resection margin assessment in patients with oral cavity squamous cell carcinoma.…”

“…Recent articles have tried to approach this question, which was not assessed in our international study. [3][4][5][6][7] The main finding of these studies was that local control is reduced in patients with positive intraoperative frozen sections, despite the extension of surgery to obtain negative resection margins. Based on a previous prospective study performed at Rambam Health Care Campus, we estimate that the rate for this subgroup varies and is within the range of 10% to 30% depending on the method of resection margin assessment.…”