Wong Ling Siew, McMahon Jeremy, Devine John, McLellan Douglas, Thompson Ewen, Farrow Adrian, Moos Khursheed, Ayoub Ashraf
Department Oral & Maxillofacial Surgery, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, United Kingdom.
Br J Oral Maxillofac Surg. 2012 Mar;50(2):102-8. doi: 10.1016/j.bjoms.2011.05.008. Epub 2011 Jul 13.
There is a lack of consistency among published reports in the definition of what constitutes close resection margins (1-5mm) in the surgical treatment of oral and oropharyngeal squamous cell carcinoma (SCC). Our aim was to define what would constitute close resection margins in predicting local recurrence and disease-specific survival. The study comprised 192 previously untreated patients with oral and oropharyngeal SCC who were recruited at the Southern General Hospital, Glasgow, from 2001 to 2007 with a minimum follow-up of 2 years. Resection was the primary treatment and the surgical margins were recorded for all patients. Statistical analyses were aided by the Statistical Package for the Social Sciences, version 15.0, and MedCalc software. The status of the surgical margins was evaluated using a receiver operating characteristic (ROC) curve to define the cut-off point. Cox's proportional hazard model was used to establish predictive factors for local recurrence and disease-specific survival. Of 192 patients, 23 (12%) had involved margins (<1.0mm), 107 (56%) had close margins (1.0-2.0mm (16.1%); 2.1-3.0mm (12%); 3.1-4.0mm (10.4%); 4.1-5.0mm (17.2%), and 62 (32.3%) had clear margins (>5mm). No predictive cut-off point was found that related close surgical margins to local recurrence. However, there was a significant adverse association between surgical margins ≤1.6mm and disease-specific survival. In recommending postoperative adjuvant treatment for oral and oropharyngeal SCC, we suggest that surgical margins within 2mm should be considered as the cut-off. However, other clinical and pathological prognostic factors should also be taken into consideration when recommending further treatment.
在口腔和口咽鳞状细胞癌（SCC）的外科治疗中，关于切缘距离多近才算切缘接近（1 - 5毫米），已发表的报告中缺乏一致性定义。我们的目的是明确在预测局部复发和疾病特异性生存方面，何种情况构成切缘接近。该研究纳入了192例既往未接受过治疗的口腔和口咽SCC患者，这些患者于2001年至2007年在格拉斯哥南部总医院招募，最短随访期为2年。手术切除是主要治疗方式，记录了所有患者的手术切缘情况。使用社会科学统计软件包15.0版和MedCalc软件辅助进行统计分析。通过绘制受试者工作特征（ROC）曲线来评估手术切缘状态，以确定临界值。采用Cox比例风险模型来确定局部复发和疾病特异性生存的预测因素。192例患者中，23例（12%）切缘受累（<1.0毫米），107例（56%）切缘接近（1.0 - 2.0毫米（16.1%）；2.1 - 3.0毫米（12%）；3.1 - 4.0毫米（10.4%）；4.1 - 5.0毫米（17.2%）），62例（32.3%）切缘阴性（>5毫米）。未发现能将切缘接近与局部复发相关联的预测临界值。然而，手术切缘≤1.6毫米与疾病特异性生存之间存在显著的不良关联。在推荐口腔和口咽SCC的术后辅助治疗时，我们建议将2毫米以内的手术切缘视为临界值。不过，在推荐进一步治疗时，还应考虑其他临床和病理预后因素。
