Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Otorhinolaryngology - Head and Neck Surgery, Kangpook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Oral Oncol. 2024 Dec;159:107046. doi: 10.1016/j.oraloncology.2024.107046. Epub 2024 Sep 27.
In cases of positive resection margin (RM), re-resection is generally recommended. There has been controversy about the oncologic impact of revised negative RMs after re-resection. The aim of this study was to investigate the oncologic impact of revised negative RM in patients who underwent surgery without adjuvant therapy for early-stage (pT1-2/N0) oral tongue squamous cell carcinoma (OSCC).
We retrospectively analyzed patients with pT1-2 N0 OSCC who did not receive adjuvant therapy (N=441). These patients were classified into an initial negative RM (R0, n = 380) group and a revised negative RM (R1-R0, n = 61) group. Demographic and clinical data (T stage, tumor length, depth of invasion [DOI], lymphovascular invasion [LVI], perineural invasion [PNI], and recurrence) were compared between the R0 and R1-R0 groups.
Age, sex, T stage, DOI, LVI, PNI, and SUVmax were not significantly different between the two groups. Local recurrence was more frequent (P=0.045) in the R1-R0 group (13.1 %) than in the R0 group (5.5 %). Local recurrence-free survival was better in the R0 group than in the R1-R0 group (P=0.046). There was no significant difference in overall recurrence or overall survival. On multivariate analysis, initial positive RM was the independent significant risk factor (hazard ratio, 2.249; 95 % confidence interval, 1.025-4.935; P=0.043) for local recurrence.
A revised clear RM after initial cut-through margin is a risk factor for local recurrence in early-stage OSCC. Cautious should be considered in early-stage OSCC patients with revised clear RM.
在切缘阳性（RM）的情况下，一般建议再次切除。对于再次切除后修订的阴性 RM 的肿瘤学影响一直存在争议。本研究旨在探讨未接受辅助治疗的早期（pT1-2/N0）口腔舌鳞状细胞癌（OSCC）患者手术中修订的阴性 RM 对肿瘤学的影响。
我们回顾性分析了未接受辅助治疗（N=441）的 pT1-2 N0 OSCC 患者。这些患者分为初始阴性 RM（R0，n=380）组和修订阴性 RM（R1-R0，n=61）组。比较 R0 和 R1-R0 组之间的人口统计学和临床数据（T 分期、肿瘤长度、浸润深度[DOI]、淋巴血管侵犯[LVI]、神经周围侵犯[PNI]和复发）。
两组之间的年龄、性别、T 分期、DOI、LVI、PNI 和 SUVmax 无显著差异。R1-R0 组（13.1%）局部复发率（P=0.045）高于 R0 组（5.5%）。R0 组局部无复发生存率优于 R1-R0 组（P=0.046）。总复发率或总生存率无显著差异。多因素分析显示，初始阳性 RM 是局部复发的独立显著危险因素（危险比，2.249；95%置信区间，1.025-4.935；P=0.043）。
初始切缘阳性 RM 后修订的清晰 RM 是早期 OSCC 局部复发的危险因素。对于修订的清晰 RM 的早期 OSCC 患者，应谨慎考虑。
