Klibngern Hanpon, Kang Chung-Jan, Lee Li-Yu, Ng Shu-Hang, Lin Chien-Yu, Fan Kang-Hsing, Chen Wen-Cheng, Lin Jin-Ching, Tsai Yao-Te, Lee Shu-Ru, Chien Chih-Yen, Hua Chun-Hung, Wang Cheng-Ping, Chen Tsung-Ming, Terng Shyuang-Der, Tsai Chi-Ying, Wang Hung-Ming, Hsieh Chia-Hsun, Yeh Chih-Hua, Lin Chih-Hung, Tsao Chung-Kan, Cheng Nai-Ming, Fang Tuan-Jen, Huang Shiang-Fu, Lee Li-Ang, Fang Ku-Hao, Wang Yu-Chien, Lin Wan-Ni, Hsin Li-Jen, Yen Tzu-Chen, Wen Yu-Wen, Liao Chun-Ta
Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
Oral Oncol. 2024 Dec;159:107102. doi: 10.1016/j.oraloncology.2024.107102. Epub 2024 Nov 2.
The prognostic significance of margin-to-depth ratio (MDR) in oral cavity squamous cell carcinoma (OCSCC) remains unclear, particularly in comparison to traditional margin status. We aimed to examine the association between MDR and clinical outcomes in a large Taiwanese cohort.
A total of 18,324 patients with first primary OCSCC were categorized by margin status: positive (1013), <5 mm (8371), and ≥ 5 mm (8940). Disease-specific survival (DSS) and overall survival (OS) served as the main outcome measures.
After excluding patients with positive margins (MDR = 0), the optimal MDR cutoff value for DSS and OS was 0.6. Patients with MDR > 0.6 showed significantly better 5-year DSS and OS rates (87 %, 81 %) compared to those with MDR ≤ 0.6 (71 %, 63 %) and MDR = 0 (53 %, 43 %). Multivariable analysis identified MDR ≤ 0.6 as independently associated with both DSS and OS in the entire cohort (hazard ratio [HR] = 1.34/1.32). This finding was consistent in the subgroups with surgical margins < 5 mm (HR = 1.39 for DSS and 1.38 for OS) and margins ≥ 5 mm (HR = 1.21 for both DSS and OS). In subgroups with surgical margins < 5 mm and ≥ 5 mm, an MDR > 0.6 was associated with better survival outcomes.
An MDR (cutoff: 0.6) is independently associated with prognosis in OCSCC, offering improved risk stratification compared to margin status alone. While MDR may guide surgical margin modification, further research is needed to determine whether MDR could serve as a postoperative indicator for adjuvant therapy in patients with close or clear margins.
口腔鳞状细胞癌（OCSCC）中切缘深度比（MDR）的预后意义仍不明确，尤其是与传统的切缘状态相比。我们旨在研究台湾一个大型队列中MDR与临床结局之间的关联。
总共18324例首次原发性OCSCC患者按切缘状态分类：阳性（1013例）、<5mm（8371例）和≥5mm（8940例）。疾病特异性生存（DSS）和总生存（OS）作为主要结局指标。
排除切缘阳性（MDR = 0）的患者后，DSS和OS的最佳MDR临界值为0.6。与MDR≤0.6（71%，63%）和MDR = 0（53%，43%）的患者相比，MDR>0.6的患者5年DSS和OS率显著更高（87%，81%）。多变量分析确定在整个队列中MDR≤0.6与DSS和OS均独立相关（风险比[HR]=1.34/1.32）。这一发现在内切缘<5mm（DSS的HR = 1.39，OS的HR = 1.38）和≥5mm（DSS和OS的HR均 = 1.21）的亚组中是一致的。在内切缘<5mm和≥5mm的亚组中，MDR>0.6与更好的生存结局相关。
MDR（临界值：0.6）与OCSCC的预后独立相关，与单独的切缘状态相比，能提供更好的风险分层。虽然MDR可能指导手术切缘的调整，但还需要进一步研究以确定MDR是否可作为切缘接近或切缘阴性患者辅助治疗的术后指标。
