Binahmed Abdulaziz, Nason Richard W, Abdoh Ahmed A
Department of Oral and Maxillofacial Surgery, Winnipeg, Man., Canada.
Oral Oncol. 2007 Sep;43(8):780-4. doi: 10.1016/j.oraloncology.2006.10.001. Epub 2006 Dec 14.
The objective of surgical management of squamous cell carcinoma of the oral cavity is adequate resection with a clear margin. This study examines the significance of the positive surgical margin. An historical cohort of 425 patients from the cancer registry of the Province of Manitoba with squamous cell carcinoma of the oral cavity treated with surgery +/-radiotherapy was examined. A Cox's proportional hazard model was used to examine the independent effect of surgical margins on five-year survival. Seventy-two percent of tumors involved the tongue and floor of mouth, and 43% of patients presented with Stage III and IV disease. The 5-year absolute and disease specific survivals were 62% and 74.5% respectively. Survival was related to age >65 years (P=0.0177), T-Stage (P=0.0002), and N-Stage (P=0.0465). Patients with clear margins had a survival rate of 69% at 5 yrs (median survival >60 mos) compared to 58% with close (median survival >60 mos) and 38% with involved margins (median survival 31 mos, P=.0000). After controlling for significant prognostic factors, involved surgical margins increased the risk of death at 5 years by 90% (HR 1.9, 95% CI 1.2,2.9, P=0.0026). The status of the surgical margin is an important predictor of outcome. The surgical margin, in contrast to the other prognostic indicators, is under the direct control of the surgeon.
口腔鳞状细胞癌手术治疗的目标是进行充分切除且切缘清晰。本研究探讨了手术切缘阳性的意义。对来自曼尼托巴省癌症登记处的425例接受手术±放疗的口腔鳞状细胞癌患者的历史队列进行了研究。使用Cox比例风险模型来检验手术切缘对五年生存率的独立影响。72%的肿瘤累及舌和口底，43%的患者为Ⅲ期和Ⅳ期疾病。5年绝对生存率和疾病特异性生存率分别为62%和74.5%。生存率与年龄>65岁（P = 0.0177）、T分期（P = 0.0002）和N分期（P = 0.0465）有关。切缘清晰的患者5年生存率为69%（中位生存期>60个月），相比之下，切缘接近的患者为58%（中位生存期>60个月），切缘受累的患者为38%（中位生存期31个月，P = 0.0000）。在控制了显著的预后因素后，手术切缘受累使5年死亡风险增加了90%（风险比1.9，95%可信区间1.2,2.9，P = 0.0026）。手术切缘状态是预后的重要预测指标。与其他预后指标相比，手术切缘直接受外科医生控制。
