Impact of Closest Margin Distance in Oral Cavity Squamous Cell Carcinoma Patients

Presentation: AHNS23
Topic: Oral Cavity
Type: Oral
Date: Wednesday, April 27, 2022
Session: 4:15 PM – 5:00 PM Oral Larynx
Authors: Wenda Ye, MD1; Kevin Guo2; Jean-Nicolas Gallant, MD, PhD1; Madelyn Stevens, MD1; Veerain Gupta2; Kayvon Sharif2; Vivian Weiss, PhD3; Eben Rosenthal, MD1; Young Kim, MD, PhD1; James Netterville, MD1; Kyle Mannion, MD1; Alexander Langerman, MD, SM, FACS1; Sarah Rohde, MD1; Robert Sinard, MD, FACS1; Michael Topf, MD1
Institution(s): 1Vanderbilt University Medical Center Department of Otolaryngology - Head and Neck Surgery; 2Vanderbilt University School of Medicine; 3Vanderbilt University Medical Center Department of Pathology, Microbiology, and Immunology


Background/Rationale:

Oral cavity squamous cell carcinoma (OCSCC) is generally treated with primary surgical resection. When multiple subsites are involved the patient requires an oral cavity composite resection (OCCR). There is uniform agreement about the importance of negative margins in surgery for OCSCC with a negative margin traditionally defined as greater than 5.0 mm clearance from the tumor. The precise cutoff at which patients are at higher risk with a close margin is less clear. The objective of this study is to determine the impact of closest margin on survival in a large cohort of patients with OCSCC.

Methods: Analysis was completed on a retrospective case series of all OCCRs performed at a single quaternary care facility between 1999 and 2020. A combination of manual and automated data extraction was used to identify/verify patients who underwent OCCR along with associated demographics and clinical information.

Results: 445 patients with previously untreated OCSCC who underwent OCCR were included in the analysis. Of these, margin data was available for 274 patients with 39 (14.2%) patients with positive margins, 148 (54.0%) with a closest margin distance of 1-2.9mm, 45 (16.4%) with a closest margin distance of 3-4.9mm, and 42 (15.3%) with a closest margin distance of 5mm and above. Of these patients, 41 (14.7%) had T1 disease, 60 (21.5%) T2, 33 (11.8%) T3, and 145 (51.9%) T4.  In direct pair-wise comparisons, no significant differences in local recurrence free survival (LRFS) were seen between margin distance groups. However, an observed trend towards improved LRFS was seen in patients with margins of 5.0 mm and greater when compared to those with positive margins (p = 0.25).

Conclusions: In this study, among OCSCC patients local recurrence free survival was not significantly impacted by distance of the closest margin. There was an observed trend towards improved LRFS with margins 5mm and more, however this was not statistically significant in our analysis. These findings suggest that the traditional definition of 5.0 mm negative margins appear to be appropriate for OCSCC.