Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, India.
Department of Pathology, Tata Memorial Centre and HBNI, India.
Oral Oncol. 2020 Dec;111:104938. doi: 10.1016/j.oraloncology.2020.104938. Epub 2020 Jul 30.
To evaluate the impact of progressively increasing margin distances on locoregional recurrence-free survival (LFRS) and determine an optimum margin distance for tongue cancers.
We retrospectively reviewed the records of patients with squamous carcinoma of oral tongue, surgically treated between January 2012 and December 2013. The patients were divided based on ROC derived optimal distance and differences in LRFS per millimeter: margin distances with no significant difference in LRFS starting from 0 mm onwards (Group-I), from upper limit of Group-I to ROC cut-off (Group-II), and all values above it (Group-III). Group-II and III were matched for clinicopathologic factors and type of adjuvant therapy received.
451 patients had a median LRFS of 29.4 months that included 32.1% of Stage I/II and 51.7% of Stage III/IV. Group-I consisted of 0--2.0 mm (2.0-2.1 mm (p-0.029)), Group-II form 2.1 to 7.5 (7.5-7.6 mm (p-0.042)) and Group-III were ≥ 7.6 mm. In the matched group, each millimeter increase in margin provided a 3.67 months survival advantage from 2.1 mm to 7.5 mm while a substantial advantage of 15 months was seen from 7.5 to 7.6 mm. No significant advantage was gained in LRFS when the margin was increased by a millimeter from the cut-off value (p-0.602). Among the patients that were not prescribed any adjuvant therapy, a significantly better LRFS was observed in Group III than Group II (HR-3.01, p-value = 0.002).
Based on these results, adequacy of surgical margins should be re-considered for oral tongue cancers.
评估逐渐增加切缘距离对局部无复发生存率（LRFS）的影响，并确定舌癌的最佳切缘距离。
我们回顾性分析了 2012 年 1 月至 2013 年 12 月期间接受手术治疗的口腔舌鳞癌患者的病历。根据 ROC 得出的最佳距离和每毫米 LRFS 差异，将患者分为以下三组：LRFS 无显著差异的切缘距离从 0mm 开始（组 I）、从组 I 的上限到 ROC 截止值（组 II）以及所有大于截止值的距离（组 III）。组 II 和 III 按照临床病理因素和接受的辅助治疗类型进行匹配。
451 例患者的中位 LRFS 为 29.4 个月，其中 32.1%为Ⅰ/Ⅱ期，51.7%为Ⅲ/Ⅳ期。组 I 包括 0-2.0mm（2.0-2.1mm 之间的差异有统计学意义（p-0.029）），组 II 为 2.1-7.5mm（7.5-7.6mm 之间的差异有统计学意义（p-0.042）），组 III 为≥7.6mm。在匹配组中，切缘每增加 1mm，从 2.1mm 到 7.5mm 可获得 3.67 个月的生存优势，而从 7.5mm 到 7.6mm 可获得 15 个月的显著优势。从截止值增加 1mm 时，LRFS 无明显优势（p-0.602）。在未接受任何辅助治疗的患者中，组 III 的 LRFS 明显优于组 II（HR-3.01，p 值=0.002）。
基于这些结果，对于口腔舌癌，应重新考虑手术切缘的充分性。
