Department of Otolaryngology, Örebro University Hospital, Södra Grev Rosengatan, 701 85, Örebro, Sweden.
School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Sci Rep. 2024 Nov 1;14(1):26347. doi: 10.1038/s41598-024-77239-3.
Surgery is the first line of treatment in gingival cancers of the mandible, and bone resection is necessary in the majority of cases. In the less extensive surgical option, marginal mandibulectomy (MM), the mandibular base is preserved. In contrast, in a segmental mandibulectomy (SM) the mandible is divided and the continuity is not preserved. If MM can be performed with comparable oncological results to SM, it is the preferred method. The aim of the present study was to identify preoperative predictors for local recurrence (LR), to support the selection of candidates for MM. Outcome measures were local recurrence free survival (LRFS) and disease specific survival (DSS). 67 patients treated with MM between 2008 and 2021 were included. Cox regression analyses of LR with hazard ratios and adjustments for postoperative radiotherapy, pathological T-stage (pT) and soft tissue margins were performed. 5-years LRFS was 63% (95% CI 46.9-75.5) and DSS 80.6% (95% CI 64.7-89.9). In conclusion we found that edentulous patients, more advanced pT-stage and positive soft tissue margins had increased risk for LR. Future studies of the correlation between cT and pT would be important to provide more robust preoperative support in the selection between MM and SM.
手术是下颌牙龈癌的一线治疗方法，大多数情况下需要进行骨切除。在手术选择范围较小的情况下，可以进行边缘下颌骨切除术 (MM)，保留下颌骨的基底。相比之下，在节段性下颌骨切除术 (SM) 中，下颌骨被分割，连续性无法保留。如果 MM 可以获得与 SM 相当的肿瘤学结果，则首选 MM。本研究旨在确定局部复发 (LR) 的术前预测因素，以支持 MM 患者的选择。结果测量包括局部无复发生存率 (LRFS) 和疾病特异性生存率 (DSS)。纳入了 2008 年至 2021 年间接受 MM 治疗的 67 例患者。对 LR 进行 Cox 回归分析，计算风险比并调整术后放疗、病理 T 分期 (pT) 和软组织切缘。5 年 LRFS 为 63% (95%CI 46.9-75.5)，DSS 为 80.6% (95%CI 64.7-89.9)。总之，我们发现无牙患者、更晚期的 pT 分期和阳性软组织切缘与 LR 风险增加相关。未来关于 cT 和 pT 之间相关性的研究将为 MM 和 SM 之间的选择提供更有力的术前支持。
