文章：

口腔癌手术切缘问题——多近才算足够？

A Matter of Margins in Oral Cancer—How Close Is Enough?

原文发布日期：12 April 2024

DOI: 10.3390/cancers16081488

类型: Article

开放获取: 是

英文摘要：

In patients with oral cancer, the risk factors for local, regional, and distant recurrence according to margin status have not been well established. We aimed to determine the risk factors for recurrence by margin status and to identify a margin cut-off point for improved survival in patients with close margins. We retrospectively reviewed adult patients treated at our centre from 2009 to 2021 for primary oral cancer. Margins were classified as positive (<1 mm), close (1 to 4.9 mm), or clear (>5 mm). Univariate and multivariate analyses were performed. A total of 326 patients (210 men) were included. The mean age was 59.1 years. Margin status was close (n = 168, 51.5%), clear (n = 83, 25.4%), or positive (n = 75, 23.0%). In the univariate analysis, positive surgical margins (HR = 7.53) had the greatest impact on distant failure. Positive surgical margins—without nodal involvement—had the greatest impact on the risk of distant failure. In the close margin group, the optimal cut-off for disease-free survival (AUC = 0.58) and overall survival (AUC = 0.63) was a deep margin > 3 mm, with survival outcomes that were comparable to the clear margin group. These finding suggest that margins < 5 mm may be sufficient in certain well-defined cases. Prospective studies are warranted to confirm these findings.

摘要翻译： 

在口腔癌患者中，根据切缘状态评估局部、区域及远处复发风险的因素尚未明确。本研究旨在通过切缘状态确定复发风险因素，并寻找可改善切缘过窄患者生存率的最佳切缘界定值。我们回顾性分析了2009年至2021年在本中心接受治疗的原发性口腔癌成年患者，将切缘分为阳性（<1毫米）、过窄（1-4.9毫米）和清晰（>5毫米）三类，并进行单变量与多变量分析。研究共纳入326例患者（男性210例），平均年龄59.1岁。切缘状态分布为：过窄168例（51.5%）、清晰83例（25.4%）、阳性75例（23.0%）。单变量分析显示，手术切缘阳性（风险比=7.53）对远处转移影响最为显著，其中无淋巴结转移的阳性切缘对远处转移风险影响最大。在切缘过窄组中，深部切缘>3毫米是无病生存（曲线下面积=0.58）和总生存期（曲线下面积=0.63）的最佳界定值，其生存结果与切缘清晰组相当。这些发现表明，在特定明确病例中，<5毫米的切缘可能已足够。需开展前瞻性研究以验证上述结论。

原文链接：

A Matter of Margins in Oral Cancer—How Close Is Enough?