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Introduction <p>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.</p> Material and methods <p>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.</p> Results <p>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.</p> Conclusion <p>Patients with OSCC and surgical margins between 1 and 5mm may derive benefits from adjuvant treatment only if classified as medium- or high-risk.</p>

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

  • 期刊论文

  • 发表日期：

    2025年12月2日

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  • Hugo Fontan Kohler,
  • Antonio Cassio Assis Pelizzon,
  • Felicia Peterson Cavalier,
  • Jose Guilherme Vartanian,
  • Clovis Antonio Lopes Pinto,
  • Thiago Bueno de Oliveira,
  • Ulisses Ribaldo Nicolau,
  • Luiz Paulo Kowalski

摘要

Introduction

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.

Material and methods

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.

Results

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.

Conclusion

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