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Background <p>A high-risk margin is a recurrence risk factor in oral squamous cell carcinoma (OSCC), but its exact definition is debated. The effectiveness of the margin-to-depth-of-invasion ratio (MDR) in identifying high-risk margin remains to be determined.</p> Methods <p>Patients who had a diagnosis of pT1-4N0 OSCC with negative margins (margin &gt; 1&#xa0;mm) recorded in the Taiwan Cancer Registry between January 2018 and December 2021 were reviewed. All patients were categorized into two groups: MDR &lt; 0.5 and MDR ≥ 0.5.</p> Results <p>The study analyzed 7420 OSCC patients without a positive margin. Of these 7420 patients, 4669 (62.92%) had an MDR ≥ 0.5, and 2751 (37.08%) had an MDR &lt; 0.5. The group with an MDR &lt; 0.5 exhibited significantly poorer 3-year disease-free survival (DFS, 74% vs 86%) and overall survival (OS, 79% vs 89%) than the group with an MDR ≥ 0.5. Despite a higher rate of postoperative radiotherapy (PORT) in the group with an MDR &lt; 0.5, multivariate Cox analysis showed that patients with a margin &lt; 5&#xa0;mm and an MDR ≥ 0.5 had a significantly better DFS than those with a margin &lt; 5&#xa0;mm and an MDR &lt; 0.5 (<i>p </i>= 0.001). Treatment with PORT improved DFS and OS for the patients with an MDR &lt; 0.5, but worsened outcomes for the patients with an MDR ≥ 0.5.</p> Conclusion <p>For OSCC patients without positive margin, an MDR &lt; 0.5 was associated with worse survival and higher locoregional recurrence risk. The patients with an MDR &lt; 0.5 may benefit from PORT, whereas those with an MDR ≥ 0.5 could experience worse outcomes. An MDR &lt; 0.5 could serve as a criterion for high-risk OSCC margin.</p>

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Risk Classification of Oral Cancer Surgical Margins: Margin to Depth of Invasion Ratio Analysis

  • 期刊论文

  • 发表日期：

    2025年4月23日

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  • Chun-Yang Hung,
  • Li-Jen Liao,
  • Yu-Ping Cheng,
  • Wan-Lun Hsu,
  • Chun-Ju Chiang,
  • Chun-Wei Chang,
  • Wen-Chung Lee,
  • Cheng-Ping Wang,
  • Pei-Jen Lou,
  • Yih-Leong Chang,
  • Tseng-Cheng Chen

摘要

Background

A high-risk margin is a recurrence risk factor in oral squamous cell carcinoma (OSCC), but its exact definition is debated. The effectiveness of the margin-to-depth-of-invasion ratio (MDR) in identifying high-risk margin remains to be determined.

Methods

Patients who had a diagnosis of pT1-4N0 OSCC with negative margins (margin > 1 mm) recorded in the Taiwan Cancer Registry between January 2018 and December 2021 were reviewed. All patients were categorized into two groups: MDR < 0.5 and MDR ≥ 0.5.

Results

The study analyzed 7420 OSCC patients without a positive margin. Of these 7420 patients, 4669 (62.92%) had an MDR ≥ 0.5, and 2751 (37.08%) had an MDR < 0.5. The group with an MDR < 0.5 exhibited significantly poorer 3-year disease-free survival (DFS, 74% vs 86%) and overall survival (OS, 79% vs 89%) than the group with an MDR ≥ 0.5. Despite a higher rate of postoperative radiotherapy (PORT) in the group with an MDR < 0.5, multivariate Cox analysis showed that patients with a margin < 5 mm and an MDR ≥ 0.5 had a significantly better DFS than those with a margin < 5 mm and an MDR < 0.5 (p = 0.001). Treatment with PORT improved DFS and OS for the patients with an MDR < 0.5, but worsened outcomes for the patients with an MDR ≥ 0.5.

Conclusion

For OSCC patients without positive margin, an MDR < 0.5 was associated with worse survival and higher locoregional recurrence risk. The patients with an MDR < 0.5 may benefit from PORT, whereas those with an MDR ≥ 0.5 could experience worse outcomes. An MDR < 0.5 could serve as a criterion for high-risk OSCC margin.