Department of Surgical Oncology, AIIMS Bhubaneswar, Odisha, India.
Department of Radiation Oncology, AIIMS Bhubaneswar, Odisha, India.
JCO Glob Oncol. 2023 Aug;9:e2300144. doi: 10.1200/GO.23.00144.
A common definition of a clear margin (≥5 mm) in oral squamous cell carcinoma (OSCC) for all stages is a subject of controversy. Studies have shown that even 1- and 2-mm margins are adequate, and few studies have identified dynamic resection margin as a criterion. We aimed to study the margin to depth of invasion ratio (MDR), margin to tumor thickness ratio (MTR), and margin to tumor size ratio (MSR) as prognostic markers for survival. Notably, to our knowledge, this is the first study to evaluate the role of MDR in OSCC.
A prospectively maintained head and neck cancer database was analyzed from January 2017 to February 2023. The MDR, MTR, and MSR were calculated for each patient. Survival outcomes were analyzed using the Cox proportional model and the Kaplan-Meier method. Akaike's information criterion (AIC) and Bayesian information criterion (BIC) were used to compare different ratio models. X-tiles software was used to identify the optimal cutoff value of MDR.
Two hundred eighty patients in the database were assessed, of which 123 eligible patients were enrolled in the study. MDR was an independent predictor of disease-free survival (DFS) on multivariate analysis. The MDR model had the lowest values on AIC and BIC analyses. A cutoff value of 0.5 for MDR showed a significant correlation with DFS and overall survival.
MDR was the best predictor of recurrence of all the three ratios studied. The minimum safe surgical margin can be calculated by multiplying the depth of invasion by 0.5. This study signifies the role of dynamic resection margin criteria on the basis of MDR in defining clear margins.
对于所有阶段的口腔鳞状细胞癌（OSCC），一个常见的定义是清晰切缘（≥5mm），但这存在争议。研究表明，即使是 1-2mm 的切缘也是足够的，并且很少有研究将动态切缘作为标准。我们旨在研究切缘至浸润深度比（MDR）、切缘至肿瘤厚度比（MTR）和切缘至肿瘤大小比（MSR）作为生存的预后标志物。值得注意的是，据我们所知，这是第一项评估 MDR 在 OSCC 中的作用的研究。
分析了 2017 年 1 月至 2023 年 2 月期间前瞻性维护的头颈部癌症数据库。计算了每位患者的 MDR、MTR 和 MSR。使用 Cox 比例模型和 Kaplan-Meier 方法分析生存结果。采用赤池信息量准则（AIC）和贝叶斯信息量准则（BIC）比较不同比模型。使用 X-tiles 软件确定 MDR 的最佳截断值。
数据库中评估了 280 例患者，其中 123 例符合条件的患者被纳入研究。MDR 是多变量分析中无病生存（DFS）的独立预测因子。MDR 模型在 AIC 和 BIC 分析中的值最低。MDR 的截断值为 0.5 时与 DFS 和总生存显著相关。
MDR 是所研究的三个比率中复发的最佳预测因子。最小安全手术切缘可通过将浸润深度乘以 0.5 来计算。这项研究基于 MDR 确定了动态切缘标准在定义清晰切缘中的作用。
