Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America.
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States of America.
Am J Otolaryngol. 2021 Sep-Oct;42(5):103012. doi: 10.1016/j.amjoto.2021.103012. Epub 2021 Mar 29.
Planned flap reconstruction, allowing aggressive resections of oral cavity squamous cell carcinoma (OCSCC), may decrease positive surgical margins. The purpose of this study was to determine if length of stay (LOS), as a proxy measure for flap reconstruction, is associated with positive margin rates in OCSCC.
Data from the National Cancer Database was retrospectively collected for patients undergoing surgery for previously untreated clinical T1-3 OCSCC. Post-operative LOS was dichotomized between ≤4 and >4 days as a proxy measure for whether patients may have received flap reconstruction. Patients with LOS >4 days represent a diverse group, but those with a LOS ≤4 days are less likely to have undergone an oral cavity flap reconstruction.
10,107 patients were included, of which 5290 (52%) were clinical T1 and 4852 (48%) were clinical T2-3. 771 (8%) patients had a positive surgical margin. On multivariable logistic regression analysis, LOS ≤4 days was significantly associated with a positive margin resection in patients with clinical T2-3 tumors (OR 1.68, 95%CI 1.37-2.06) compared to patients with LOS >4 days. LOS was not associated with surgical margin status in patients with clinical T1 disease (OR 0.76, 95%CI 0.55-1.06). Patients with positive margin resections demonstrated worse overall survival (cT1: OR 1.35, 95%CI 1.06-1.72; cT2-3: OR 1.52, 95%CI 1.33-1.74).
LOS >4 days after oral cavity cancer resection was significantly associated with negative surgical margins in clinical T2-3 oral cavity cancer, suggesting the possibility that patients undergoing flap reconstruction after resection have fewer positive surgical margins.
计划性皮瓣重建术可允许对口腔鳞状细胞癌（OCSCC）进行积极的切除，从而降低阳性手术切缘率。本研究旨在确定作为皮瓣重建术替代指标的住院时间（LOS）是否与 OCSCC 的阳性切缘率相关。
回顾性收集国家癌症数据库中接受手术治疗未经治疗的临床 T1-3 期 OCSCC 患者的数据。将术后 LOS 分为≤4 天和>4 天两组，作为是否接受皮瓣重建术的替代指标。LOS>4 天的患者代表了一个多样化的群体，但 LOS≤4 天的患者不太可能接受口腔皮瓣重建术。
共纳入 10107 例患者，其中 5290 例（52%）为临床 T1 期，4852 例（48%）为临床 T2-3 期。771 例（8%）患者存在阳性手术切缘。多变量逻辑回归分析显示，与 LOS>4 天的患者相比，LOS≤4 天的患者在临床 T2-3 肿瘤患者中发生阳性切缘切除的风险显著增加（OR 1.68，95%CI 1.37-2.06）。在临床 T1 疾病患者中，LOS 与手术切缘状态无关（OR 0.76，95%CI 0.55-1.06）。发生阳性切缘切除的患者总生存较差（cT1：OR 1.35，95%CI 1.06-1.72；cT2-3：OR 1.52，95%CI 1.33-1.74）。
口腔癌切除后 LOS>4 天与临床 T2-3 口腔癌的阴性手术切缘显著相关，这表明接受切除后皮瓣重建术的患者阳性手术切缘率可能较低。
