Petrovic Ivana, Montero Pablo H, Migliacci Jocelyn C, Palmer Frank L, Ganly Ian, Patel Snehal G, Shah Jatin P
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, United States.
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, United States.
J Craniomaxillofac Surg. 2017 Feb;45(2):252-257. doi: 10.1016/j.jcms.2016.11.017. Epub 2016 Nov 30.
Marginal mandibulectomy (MM) is indicated for oral cavity squamous cell carcinomas (OCSCC) that abut or minimally erode the mandible without gross invasion. Successful implementation of MM is predicated on accurate patient selection and appropriate adjuvant treatment based on well-known host and tumor characteristics. The incidence of microscopically diagnosed bone involvement in MM specimens and its implications on outcomes have however not been reported in large contemporary series.
To report the incidence of bone involvement and analyze its influence on oncologic outcomes in selected patients who underwent MM in treatment of OCSCC.
A retrospective cohort study was performed on a consecutive series of previously untreated patients requiring MM, at a tertiary care cancer center, between 1985 and 2012 (n = 326). The median age was 64 years and 59% were male. The majority of patients (67%) had a primary tumor of the floor of the mouth or lower alveolus, 80% were clinically staged T1-2, and 31% were clinically N+. Postoperative radiation (PORT) was used in 27% and chemoradiation (POCTRT) in 8% of patients who had microscopic bone invasion. The median follow up period was 55 months and endpoints of interest were local and regional recurrence free (LRFS and RRFS) and disease specific (DSS) survival.
Microscopic bone invasion was present in 15% of patients (n = 49). Among these, cortical invasion was present in 32, medullary in 13, and it was not specified in 4. Eight patients had microscopic positive bone margins. Positive bone margins were associated with medullary bone involvement (p < 0.001), floor of mouth and buccal mucosa primary site (p = 0.03), and positive soft tissue margins (p = 0.06). LRFS and DSS were similar in patients without versus with bone invasion (62.8% vs 79.7% and 76.2% vs 66% respectively, p = NS). LRFS were similar in patients with microscopic positive versus negative bone margins, as long as postoperative adjuvant treatment was administered.
Microscopic bone involvement does not adversely influence outcomes but medullary bone involvement does confer a higher risk of positive bone margins. MM and appropriate adjuvant treatment is an effective strategy for treatment of OCSCC in selected patients with primary tumors adherent to or in proximity to the mandible.
边缘性下颌骨切除术（MM）适用于紧邻或轻微侵蚀下颌骨但无明显侵犯的口腔鳞状细胞癌（OCSCC）。MM的成功实施取决于准确的患者选择以及基于众所周知的宿主和肿瘤特征进行适当的辅助治疗。然而，在当代大型系列研究中，尚未报道MM标本中显微镜下诊断的骨受累发生率及其对预后的影响。
报告骨受累的发生率，并分析其对接受MM治疗OCSCC的选定患者肿瘤学预后的影响。
对1985年至2012年期间在一家三级癌症中心接受MM治疗的一系列连续的未经治疗的患者进行回顾性队列研究（n = 326）。中位年龄为64岁，59%为男性。大多数患者（67%）原发肿瘤位于口底或下牙槽，80%临床分期为T1-2，31%临床N+。27%的患者接受了术后放疗（PORT），8%显微镜下有骨侵犯的患者接受了放化疗（POCTRT）。中位随访期为55个月，关注的终点为局部和区域无复发生存期（LRFS和RRFS）以及疾病特异性生存期（DSS）。
15%的患者（n = 49）存在显微镜下骨侵犯。其中，32例有皮质侵犯，13例有髓质侵犯，4例未明确说明。8例患者显微镜下骨切缘阳性。骨切缘阳性与髓质骨受累（p < 0.001）、口底和颊黏膜原发部位（p = 0.03）以及软组织切缘阳性（p = 0.06）相关。无骨侵犯与有骨侵犯的患者的LRFS和DSS相似（分别为62.8%对79.7%和76.2%对66%，p = 无显著性差异）。只要进行了术后辅助治疗，显微镜下骨切缘阳性与阴性的患者的LRFS相似。
显微镜下骨受累不会对预后产生不利影响，但髓质骨受累确实会增加骨切缘阳性的风险。MM及适当的辅助治疗是治疗选定的原发肿瘤紧贴或靠近下颌骨的OCSCC患者的有效策略。
