Impact of stratified resection margin classification on local tumor control and survival in patients with oral squamous cell carcinoma

Abstract

Background Guidelines recommended for resection of oral cancer define a free margin of ≥5 mm as clear and safe (R0). This statement was questioned recently based on the assumption that different surgical margins may hold different risk categories. The aim of this study was to investigate the impact of stratification of the surgical margins on the survival outcome of patients with oral cancer. Methods In a cohort of 753 patients, the hazard ratio for local recurrence‐free survival (LRFS), overall survival (OS), and oral cancer‐specific survival (OCSS) were estimated for R0 resection, the close margin of 1–4 mm, involved resection borders but with free frozen sections. Competing risk factors were considered in the statistical regression model. Results One hundred seventy‐three (23%) patients developed local recurrence and 316 (42%) died in the 5 follow‐up years. There was a gradual improvement in the LRFS, OCSS, OS with the increase of clear margin. OS showed a similar tendency. Conclusion Not all patients with an R0cm status carry the same risk for impaired LRFS, OCSS, and OS. Their risk to develop recurrence is higher than those patients with R0 ≥5 mm but stratified risk management can be recommended according to the presented results.

Adding Concomitant Chemotherapy to Postoperative Radiotherapy in Oral Cavity Carcinoma with Minor Risk Factors: Systematic Review of the Literature and Meta-Analysis

“…Additional bias could affect the assessment of tumor borders and margins, including [ 131 ] their processing, and, eventually, lead to inadequate orientation of the tumor specimen—in many cases, aggravated by complex tumor shapes and sites. Furthermore, variable capacities in margin status prediction could result from the different intraoperative methods used to assess resection margins [ 127 ] and postresection shrinkage [ 131 ].…”

“…Additional bias could affect the assessment of tumor borders and margins, including [ 131 ] their processing, and, eventually, lead to inadequate orientation of the tumor specimen—in many cases, aggravated by complex tumor shapes and sites. Furthermore, variable capacities in margin status prediction could result from the different intraoperative methods used to assess resection margins [ 127 ] and postresection shrinkage [ 131 ]. In particular, the reduction of tumor margin measurements (shrinkage), which occurs between the surgical pre-incision/excision processes and the histopathological evaluation [ 132 ], has been proposed as a potential cause for close pathological margins and requires prudential considerations by surgeons at the initial planning of resection margins.…”

Downregulation of circLPAR3 inhibits tumor progression and glycolysis by liberating miR‐144‐3p and upregulating LPCAT1 in oral squamous cell carcinoma

“…Surgery combined with immune checkpoint inhibitors, chemotherapy, and radiotherapy is the main treatment strategy for OSCC 2 . Studies have shown that up to 40% of patients have disease recurrence within 2 years after treatment 3,4 . Therefore, understanding the advancement of OSCC at the molecular level is indispensable for discovering new therapeutic targets for this disease.…”

“…2 Studies have shown that up to 40% of patients have disease recurrence within 2 years after treatment. 3,4 Therefore, understanding the advancement of OSCC at the molecular level is indispensable for discovering new therapeutic targets for this disease.…”

Extracellular ATP Induced S-Phase Cell Cycle Arrest via P2Y Receptor-Activated ERK Signaling in Poorly Differentiated Oral Squamous Cell Carcinoma SAS Cells

“…Despite advancement in therapeutic interventions including adjuvant therapies with radiotherapy, systemic chemotherapy, and/or topical chemotherapy, an overall improvement on the 5-year survival rate in OSCC patients is still limited due to the aggressive local invasion and highly metastatic profile of OSCC [2][3][4][5]. Multiple cohort studies revealed that up to 40% of the patients experienced disease recurrence with increased tumor invasiveness within two years after completion of treatment [6][7][8]. Chemotherapy is the common choice of treatment of advanced OSCC for an overall improvement in the survival rate among patients.…”