Trends in Positive Surgical Margins in <scp>cT1‐T2</scp> Oral Cavity Squamous Cell Carcinoma

Robinson, Ellen; Lam, Austin S.; Solomon, Isaac H.; Brady, Jacob S.; Pang, John; Faraji, Farhoud; Houlton, Jeffrey; Futran, Neal D.; Barber, Brittany

doi:10.1002/lary.30033

Cited by 10 publications

(16 citation statements)

References 24 publications

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“…Robinson et al, who performed a NCDB analysis of patients with cT1-T2 disease, found the overall positive margin rate to be 7.9%. 5 They found the annual positive margin rate for early-stage disease to be decreasing from 2004 to 2016. These investigators attributed this, in part, to the fact that more patients were receiving treatment at academic centers.…”

Section: Discussionmentioning

confidence: 99%

“…these factors to be similarly associated with positive margins in cT1-T2 disease. 5,6 In addition, the odds of a positive surgical margin were nearly 2 times greater for tumors with a hard palate primary compared to those of the oral tongue. A similar increase in odds of positive margin for hard palate tumors was appreciated in cT1-T2 disease and was attributed to inability to perform frozen section analysis on bony portions of resection specimens.…”

Section: Discussionmentioning

confidence: 99%

“…A similar increase in odds of positive margin for hard palate tumors was appreciated in cT1-T2 disease and was attributed to inability to perform frozen section analysis on bony portions of resection specimens. 5 Worsening histopathologic characteristics, such as poorly differentiated histology and lymphovascular invasion, may increase the likelihood that microscopic disease extends beyond visible or palpable tumor margins.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Positive Surgical Margins in cT3‐T4 Oral Cavity Squamous Cell Carcinoma

Prasad

Topf

Clookey

et al. 2023

Otolaryngol.--head neck surg.

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ObjectivePositive surgical margins in oral cavity squamous cell carcinoma are associated with cost escalation, treatment intensification, and greater risk of recurrence and mortality. The positive margin rate has been decreasing for cT1‐T2 oral cavity cancer over the past 2 decades. We aim to evaluate positive margin rates in cT3‐T4 oral cavity cancer over time, and determine factors associated with positive margins.Study DesignRetrospective analysis of a national database.SettingNational Cancer Database 2004 to 2018.MethodsAll adult patients diagnosed between 2004 and 2018 who underwent primary curative intent surgery for previously untreated cT3‐T4 oral cavity cancer with known margin status were included. Logistic univariable and multivariable regression analyses were performed to identify factors associated with positive margins.ResultsAmong 16,326 patients with cT3 or cT4 oral cavity cancer, positive margins were documented in 2932 patients (18.1%). Later year of treatment was not significantly associated with positive margins (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.96‐1.00). The proportion of patients treated at academic centers increased over time (OR 1.02, 95% CI 1.01‐1.03). On multivariable analysis, positive margins were significantly associated with hard palate primary, cT4 tumors, advancing N stage, lymphovascular invasion, poorly differentiated histology, and treatment at nonacademic or low‐volume centers.ConclusionDespite increased treatment at academic centers for locally advanced oral cavity cancer, there has been no significant decrease in positive margin rates which remains high at 18.1%. Novel techniques for margin planning and assessment may be required to decrease positive margin rates in locally advanced oral cavity cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trends in Positive Surgical Margins in cT3‐T4 Oral Cavity Squamous Cell Carcinoma

Prasad

Topf

Clookey

et al. 2023

Otolaryngol.--head neck surg.

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“…The average travel distance was nearly twice as far for patients treated at academic facilities compared to nonacademic facilities (56 vs 28 miles, respectively). An average travel distance of over 50 miles has been used in prior studies to divide patients into “near” and “far” groups, 14 and may partially explain the higher rates of missed adjuvant therapy among patients treated at academic facilities. Although NCDB does report whether surgery and radiation were performed at the same site, there is no such data for patients who did not receive radiation, so it is unclear whether radiation treatment was available closer to home for patients who had surgery at academic centers.…”

Section: Discussionmentioning

confidence: 99%

Going Off Guidelines: An NCDB Analysis of Missed Adjuvant Therapy Among Surgically Treated Oral Cavity Cancer

Tassone

Topf

Dooley

et al. 2023

Otolaryngol.--head neck surg.

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Objective. Patient factors associated with failure to receive adjuvant therapy after oral cavity cancer resection remain understudied. Here, we identified rates of missed adjuvant therapy, determined factors associated with missed therapy, and assessed associations with survival.Study Design. Retrospective cohort.Setting. National Cancer Database.Methods. Patients with resected oral cavity squamous cell carcinoma and known adjuvant therapy status were included. T3-4 stage, N2-3 stage, and lymphovascular invasion were considered indications for adjuvant radiation. Extranodal extension or positive margins were considered indications for chemoradiation. Patient factors were examined for associations with missed adjuvant therapy. Overall survival was evaluated by Cox proportional hazard analysis.Results. A total of 53,503 patients were included. 27.5% missed adjuvant therapy altogether, and 26.7% with a documented indication for chemoradiation missed chemotherapy. Factors associated with missed adjuvant therapy were age, white race, low income, metropolitan population, increasing comorbidities, travel distance, lip primary, and treatment at the academic facility. Factors associated with missed chemotherapy were age, female sex, nontongue subsite, and treatment at a nonacademic center. Among patients with indications for adjuvant radiation, missed radiation was associated with worse overall survival (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.31-1.53). Among patients with indications for adjuvant chemoradiation, missed chemotherapy was associated with worse overall survival (HR: 1.19, 95% CI: 1.09-1.29). Conclusion.Missed adjuvant therapy occurs frequently after oral cavity resection. Patients treated at academic centers may be at risk of missed therapy related to travel distance, though these patients are more likely to receive adjuvant chemotherapy when indicated. Missed adjuvant therapy is associated with worse survival.

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“…According to the Royal College of Pathologists, histological tumor‐free margins of <1 mm are considered “involved”, 1–5 mm “close”, and >5 mm “clear” 6 . Involved margins are reported in 20%–41% of the BMSCC patients’ 7–10 . Most of these involved margins are located in the deep resection plane 11 .…”

Section: Introductionmentioning

confidence: 99%

Treatment of buccal mucosal carcinomas: A survey amongst head and neck surgeons in the Netherlands

Adriaansens

Noorlag

Bree

2023

Laryngoscope Investig Oto

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ObjectiveCurrently, there is no up‐to‐date guideline for the treatment of buccal mucosal squamous cell carcinoma (BMSCC) in the Netherlands. A questionnaire was used to investigate the opinions of Dutch head and neck surgeons on BMSCC of the cheek treatment.MethodsA questionnaire was sent to all 91 head and neck surgeons in the Netherlands. Their opinions on surgical tumor‐free margins, through‐and‐through defects, and indications for local adjuvant therapy were questioned.ResultsThe response rate was 51%. To prevent a through‐and‐through defect, 67% of the surgeons would accept a deep clinical (macroscopic) margin of ≤5 mm. The less adverse histological characteristics a tumor has, the less consensus there is amongst the surgeons for local adjuvant treatment in case of close margins.ConclusionThere is no consensus amongst Dutch head and neck surgeons about the optimal treatment for BMSCC of the cheek. There are different opinions on acceptable resection margins, indications for a through‐and‐through defect, and indications for adjuvant treatment. BMSCC of the cheek treatment should be more uniform and less surgeon dependent.Level of evidenceN/A

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Trends in Positive Surgical Margins in cT1‐T2 Oral Cavity Squamous Cell Carcinoma

Cited by 10 publications

References 24 publications

Trends in Positive Surgical Margins in cT3‐T4 Oral Cavity Squamous Cell Carcinoma

Trends in Positive Surgical Margins in cT3‐T4 Oral Cavity Squamous Cell Carcinoma

Going Off Guidelines: An NCDB Analysis of Missed Adjuvant Therapy Among Surgically Treated Oral Cavity Cancer

Treatment of buccal mucosal carcinomas: A survey amongst head and neck surgeons in the Netherlands

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