Jang Jeon Yeob, Choi Nayeon, Jeong Han-Sin
Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Cancers (Basel). 2022 Nov 21;14(22):5702. doi: 10.3390/cancers14225702.
The optimal cut-off point of the resection margin was recently debated in oral cancer. To evaluate the current evidence of the dynamic criteria of the resection margin, a review of the available literature was performed. Studies were sourced from PubMed and EMBASE by searching for the keywords "mouth neoplasm", "oral cancer", "oral cavity cancer", "oral squamous cell carcinoma", "tongue cancer", "margins of excision", "surgical margin" and "resection margin". We found approximately 998 articles on PubMed and 2227 articles on EMBASE. A total of 3225 articles was identified, and 2763 of those were left after removing the duplicates. By applying advanced filters about the relevance of the subjects, these were narrowed down to 111 articles. After the final exclusion, 42 full-text articles were reviewed. The universal cut-off criteria of 5 mm used for determining the resection margin status has been debated due to recent studies evaluating the impact of different margin criteria on patient prognosis. Of note, the degree of the microscopic extension from the gross tumor border correlates with tumor dimensions. Therefore, a relatively narrow safety margin can be justified in early-stage oral cancer without the additional risk of recurrence, while a wide safety margin might be required for advanced-stage oral cancer. This review suggests a surgical strategy to adjust the criteria for risk grouping and adjuvant treatments, according to individual tumor dimensions or characteristics. In the future, it might be possible to establish individual tumor-specific surgical margins and risk stratification during or after surgery. However, the results should be interpreted with caution because there is no strong evidence (e.g., prospective randomized controlled studies) yet to support the conclusions. Our study is meaningful in suggesting future research directions and discussions.
口腔癌切除边缘的最佳截断点最近引发了争议。为评估切除边缘动态标准的现有证据,我们对相关文献进行了综述。通过在PubMed和EMBASE中搜索关键词“口腔肿瘤”“口腔癌”“口腔癌”“口腔鳞状细胞癌”“舌癌”“切除边缘”“手术切缘”和“切除边界”来获取研究资料。我们在PubMed上找到约998篇文章,在EMBASE上找到2227篇文章。共识别出3225篇文章,去除重复项后剩下2763篇。通过应用关于主题相关性的高级筛选器,这些文章被缩减至111篇。经过最终排除,对42篇全文进行了综述。由于最近有研究评估了不同切缘标准对患者预后的影响,用于确定切除边缘状态的5毫米通用截断标准一直存在争议。值得注意的是,大体肿瘤边界的微观扩展程度与肿瘤大小相关。因此,早期口腔癌可采用相对较窄的安全切缘而无额外复发风险,而晚期口腔癌可能需要较宽的安全切缘。本综述提出了一种手术策略,可根据个体肿瘤大小或特征调整风险分组和辅助治疗标准。未来,有可能在手术期间或术后确定个体肿瘤特异性的手术切缘和风险分层。然而,由于尚无有力证据(如前瞻性随机对照研究)支持这些结论,因此对结果的解释应谨慎。我们的研究对于提出未来研究方向和讨论具有重要意义。