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Differential Impact of Close Surgical Margin on Local Recurrence According to Primary Tumor Size in Oral Squamous Cell Carcinoma

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The extent of surgical safety margin (gross tumor border to resection margin) in oral cancer surgery remains unclear, and no study has determined the differential impact of close surgical margin and microscopic extension according to primary tumor size in oral cancers.

Methods

We retrospectively analyzed the clinical data of 325 patients with surgically treated oral cavity squamous cell carcinomas to determine the effect of a close surgical margin (<5 mm) (cSM5) on local recurrence. In addition, the depth of microscopic tumor infiltration was determined in 90 available surgical specimens.

Results

The cSM5 was not related to the risk of local tumor recurrence in early-stage oral cancer, while it significantly increased the rate of local tumor recurrence in resectable advanced-stage oral cancers (hazard ratio 3.157, 95 % confidence interval 1.050–9.407, p = 0.041). Addition of postoperative adjuvant radiation to early-stage tumors with cSM5 did not further reduce the local recurrence rate compared to surgery alone. The depth of microscopic tumor extension from the gross tumor border was significantly associated with primary tumor thickness (ρ = 0.390, p < 0.001) and tumor sizes (ρ = 0.308, p = 0.003), which was a median (range) of 0.84 (0.14–2.32) mm in T1, 1.06 (0.20–4.34) mm in T2, and 1.77 (0.13–4.70) mm in T3–4.

Conclusions

The cSM5 was a significant risk factor for local recurrence only in advanced oral cancers, but not in early-stage tumors, where microscopic tumor extension was not beyond 3 mm in T1 tumors. Thus, the extent of surgical safety margin can be redefined according to the primary tumor size.

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Acknowledgment

Supported in part by the National Research Foundation of Korea grants, funded by the Korean Government MEST (2012R1A1A2040866, 2014R1A1A2055006, and 2015R1D1A1A09056771), and a Samsung Biomedical Research Institute 2016 basic-clinical collaborative research Grant.

Disclosure

The authors declare no conflict of interest.

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Author notes

    Authors and Affiliations

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea

      Jeon Yeob Jang MD, PhD

    2. Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

      Nayeon Choi MD, Man Ki Chung MD, PhD, Young-Ik Son MD, PhD, Chung-Hwan Baek MD, PhD & Han-Sin Jeong MD, PhD

    3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

      Young-Hyeh Ko MD, PhD

    4. Department of Molecular and Cellular Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine,Suwon, Gyeonggi, Republic of Korea

      Kwan-Hyuck Baek PhD

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    1. Jeon Yeob Jang MD, PhD
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    Correspondence to Han-Sin Jeong MD, PhD.

    Additional information

    Jeon Yeob Jang, Nayeon Choi, Kwan-Hyuck Baek and Han-Sin Jeong have contributed equally to this article.

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    Jang, J.Y., Choi, N., Ko, YH. et al. Differential Impact of Close Surgical Margin on Local Recurrence According to Primary Tumor Size in Oral Squamous Cell Carcinoma. Ann Surg Oncol 24, 1698–1706 (2017). https://doi.org/10.1245/s10434-016-5497-4

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    • DOI: https://doi.org/10.1245/s10434-016-5497-4

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