Incidence and impact of dysplasia at final resection margins in cancers of the oral cavity

Abstract

Background

The literature often cites margin status as being free, close or involved by tumor but there is very sparse evidence of the relevance of dysplasia at resection margin.

Aims/Objectives: To compare the impact of dysplasia at final resection margin (D-FRM) and other margin statuses on overall survival (OS) and disease free survival (DFS).

Methods

This is a retrospective review of 1700 treatment naïve oral squamous carcinoma patients who underwent surgery between January 2012 and December 2015. The study arm consisted of patients with dysplasia at final resection margin (D-FRM). Each of these patients were double propensity matched to obtain positive (P-FRM), close (C-FRM) and free final resection margins (F-FRM).

Results

There was no hazard discrimination in survival among the D-FRM and C-FRM (vs F-FRM; p-0.597, HR-1.207 (0.621–2.346) and p-0.075, HR-1.594 (0.947–2.684), respectively). A decreasing survival trend was observed as the grade and number of D-FRM margins increased. Although not significant, the addition of adjuvant therapy for D-FRM showed a trend towards improved survival outcomes compared to C-FRM, especially with chemotherapy.

Conclusion and relevance: The presence of D-FRM, irrespective of grade, had a similar impact on survival as C-FRM and underscores the possible need for treatment intensification.

Chinese abstract

背景：文献经常将切缘状态描述为宽切缘、闭合切缘或带肿瘤切缘, 但有非常少的证据表明切缘与异型增生的相关性。

目的：比较在最终切缘（D-FRM）和其它切缘状态的异型增生对总体生存率（OS）和无病生存率（DFS）的影响。

方法：这是对1700例初次治疗的口腔鳞癌患者的回顾性研究。他们在2012年1月至2015年12月期间接受了手术。研究组包括最后切缘异型增生的患者（D-FRM）。这些患者中的每一个都具有双重倾向匹配, 以获得阳性（P-FRM）、闭合（C-FRM）和宽的最终切缘（F-FRM）。

结果：D-FRM和C-FRM之间没有生存率危险方面的区别（vs F-FRM； pQ2为0.597, HR-1.207（0.621-2.346）； p-0.075, HR-1.594（0.947-2.684） ）。观察到这一趋势：生存率随着D-FRM切缘的等级和数量增加而下降。与C-FRM相比, 对D-FRM的辅助治疗, 尤其是化疗, 显示增加生存结果的趋势, 虽然这种趋势不明显。

结论和相关性：D-FRM的存在, 不管是什么等级, 对生存率的影响与C-FRM类似, 并强调可能需要加强治疗。

Keywords:

• Oral cancer
• dysplasia
• margins

Author contributions

All authors have made a significant contribution to this article from concept to implementation and publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).