Optimizing outcomes: a decision-analysis model for oral cancer patients with surgical margins of 1 to 5 mm

Adjuvant chemoradiotherapy (CRT) was evaluated by clinical trials (RCT)and cohort analysis with significant benefit in patients with extranodal extension and compromised surgical margins. But a point of contention is the definition of clear surgical margins. This article examines the application of CRT in a cohort of patients that fulfills the surgical margin criterion for one RCT but not the other RCT.

We conducted a retrospective analysis of oral squamous cell carcinoma (OSCC) patients with surgical margins between 1 and 5 mm (mm), treated at a single center.

We analyzed 375 consecutive OSCC patients. All patients underwent radical resection, with 95 patients (26.4%) receiving adjuvant radiotherapy (RT) and 83 patients (23.1%) receiving adjuvant CRT. The mean follow-up duration was 26.2 months, during with 126 patients (33.6%) died to disease progression, and 112 patients (29.9%) experienced local recurrence. In the cohort treated by surgery alone, patients were stratified into three risk groups for local recurrence-free survival based on pathological features. Low-risk patients showed no significant benefit from adjuvant treatment, while medium-risk patients derived benefit from either RT or CRT. High-risk patients demonstrated the most significant benefit from CRT. When using disease specific survival as the outcome of interest, pN classification, the worst pattern of invasion and perineural invasion distinguished low-, medium- and high-risk patients. Adjuvant treatment provided a survival benefit for those classified as medium- and high-risk.

Patients with OSCC and surgical margins between 1 and 5mm may derive benefits from adjuvant treatment only if classified as medium- or high-risk.