de Vincentiis Marco, Pagliuca Giulio, Margani Valerio, Di Stefano Vanessa, Succo Giovanni, Crosetti Erika, Piazza Cesare, Zoccali Federica, Angeletti Diletta, Gallo Andrea
Department of Sensory Organs, "Sapienza" University of Rome, Rome, Italy.
Otorhinolaryngology University Unit, "S.M. Goretti Hospital", Latina, Italy.
Acta Otorhinolaryngol Ital. 2025 May;45(Suppl. 1):S109-S120. doi: 10.14639/0392-100X-suppl.1-45-2025-N1108.
Major salivary gland malignancies (MSGM) are a rare and heterogeneous group of tumours accounting for 1-5% of all head and neck cancers. When feasible, surgical removal with negative margins is the preferred treatment, reserving adjuvant radiotherapy for adverse clinicopathological features such as high-grade, advanced-stage, extranodal extension, lympho-vascular invasion, perineural invasion, and positive margins. This systematic review aims to evaluate the current literature on the definition of negative and close margins for MSGM, their impact on loco-regional recurrence (LRR), disease-free (DFS), and overall survival (OS), and their implications in the choice of multimodal therapies.
An online search of articles published between 2004 and 2024 was carried out using PubMed via a PICO search strategy for qualitative questions and written following the PRISMA statement guidelines. The following parameters were evaluated: definition of free and close margins, and their impact on local control.
The initial search yielded 158 articles. Following the application of inclusion and exclusion criteria, 30 full-text publications were reviewed. All studies were retrospective. A total of 15,985 patients who underwent surgery were considered. Margin involvement ranged widely among the studies from 14.3% to 65.4%. Five out of 30 studies reported no data about association between margins and LRR, DFS, and OS. Twenty of 25 studies reported a significant correlation between positive margins and oncological outcomes regardless of the histological types, while 5 focused on high-stage cancers or more aggressive histotypes and described no association between margin status and oncological outcomes. Nine of 30 studies described close margins in the absence of a univocal definition of threshold for close vs. negative margins. Most studies did not report a significant correlation between close margins and oncological outcomes.
Surgical resection achieving negative margins is recommended for MSGM. Positive margin is widely considered an adverse clinicopathological feature and performing adjuvant radiotherapy has documented survival benefits. A consensus involving a definition of close margin is missing, although further treatment is not recommended, preferring a watch-and-wait approach in presence of close margins.
大唾液腺恶性肿瘤（MSGM）是一组罕见且异质性的肿瘤，占所有头颈癌的1% - 5%。在可行的情况下，手术切缘阴性切除是首选治疗方法，对于具有高级别、晚期、结外扩展、淋巴管侵犯、神经周围侵犯和切缘阳性等不良临床病理特征的患者，保留辅助放疗。本系统评价旨在评估当前关于MSGM阴性和近切缘定义的文献，它们对局部区域复发（LRR）、无病生存期（DFS）和总生存期（OS）的影响，以及它们在多模式治疗选择中的意义。
通过PubMed对2004年至2024年发表的文章进行在线搜索，采用PICO搜索策略针对定性问题进行搜索，并按照PRISMA声明指南撰写。评估了以下参数：切缘阴性和近切缘的定义及其对局部控制的影响。
初步搜索产生了158篇文章。应用纳入和排除标准后，对30篇全文出版物进行了综述。所有研究均为回顾性研究。共纳入15985例接受手术的患者。各研究中切缘受累率差异很大，从14.3%到65.4%不等。30项研究中有5项未报告切缘与LRR、DFS和OS之间关联的数据。25项研究中有20项报告无论组织学类型如何，切缘阳性与肿瘤学结局之间存在显著相关性，而5项研究聚焦于晚期癌症或侵袭性更强的组织学类型，未描述切缘状态与肿瘤学结局之间的关联。30项研究中有9项在没有近切缘与阴性切缘阈值明确统一的定义的情况下描述了近切缘。大多数研究未报告近切缘与肿瘤学结局之间存在显著相关性。
对于MSGM，建议手术切除达到切缘阴性。切缘阳性被广泛认为是一种不良临床病理特征，进行辅助放疗已证明对生存有益。目前缺乏关于近切缘定义的共识，尽管不建议进一步治疗，但对于近切缘情况更倾向于采取观察等待的方法。
