Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control.
Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control.
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早期口腔舌鳞状细胞癌：从肿瘤床边缘取样和较差的局部控制。
DOI：
10.1001/jamaoto.2015.1351
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Chiosea SI
中科院分区：
文献类型：
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作者：
Maxwell JH;Thompson LD;Brandwein-Gensler MS;Weiss BG;Canis M;Purgina B;Prabhu AV;Lai C;Shuai Y;Carroll WR;Morlandt A;Duvvuri U;Kim S;Johnson JT;Ferris RL;Seethala R;Chiosea SI
在口腔舌鳞状细胞癌（SCC）患者中，切缘阳性与预后不良相关。然而，边际抽样技术存在很大的差异。目的：探讨切缘取样技术对I、II期口腔舌鳞癌患者局部复发的影响。回顾性研究从1986年1月1日至2012年12月31日，在5个三级医疗中心对280例病理(p)T1-2 pN0口腔舌鳞癌患者进行肿瘤切除和择期颈部清扫。分析时间为2013年6月1日至2015年1月20日。第1组（n = 119）不取肿瘤床缘标本。在第二组（n = 61）中，从舌骨切除标本中检查边缘，发现阳性或次优，并修正额外的肿瘤床边缘。在第3组（n = 100）中，主要从肿瘤床上取样边缘，没有事先检查舌切除术标本。对三组患者的切缘状态（作为二元变量[阳性vs阴性]和连续变量[到切缘的距离以毫米为单位]）和其他临床病理参数进行比较，并与LR相关。局部复发。三组患者的年龄、性别、pT分期、淋巴血管或神经周围浸润及辅助放射治疗相似。第1组和第3组3年无lr生存概率分别为0.9和0.8 （P = .03）。2、3组（61例中28例[45.9%]，95例中23例[24.2%]）和1组（117例中9例[7.7%]）舌切缘阳性发生率最低（P < 0.001）。即使在排除边缘阳性的病例后，与1组（3 mm）相比，3组（2 mm）到最近边缘的中位距离明显更窄（P = 0.008）。舌切除标本的边缘状态（阳性与阴性）与LR相关（P = .007），而肿瘤床边缘状态则无关。检测舌切缘阳性的肿瘤床缘状态敏感性为24% (95% CI, 16%-34%)，特异性为92% （95% CI, 85%-97%）。切缘取样技术影响舌鳞癌患者的局部控制。依赖于肿瘤床的边缘取样与较差的局部控制相关，很可能是由于较窄的边缘清除率和较高的阳性边缘发生率。建议采用基于切除标本的切缘评估。
Positive margins are associated with poor prognosis among patients with oral tongue squamous cell carcinoma (SCC). However, wide variation exists in the margin sampling technique. To determine the effect of the margin sampling technique on local recurrence (LR) in patients with stage I or II oral tongue SCC. A retrospective study was conducted from January 1, 1986, to December 31, 2012, in 5 tertiary care centers following tumor resection and elective neck dissection in 280 patients with pathologic (p)T1-2 pN0 oral tongue SCC. Analysis was conducted from June 1, 2013, to January 20, 2015. In group 1 (n = 119), tumor bed margins were not sampled. In group 2 (n = 61), margins were examined from the glossectomy specimen, found to be positive or suboptimal, and revised with additional tumor bed margins. In group 3 (n = 100), margins were primarily sampled from the tumor bed without preceding examination of the glossectomy specimen. The margin status (both as a binary [positive vs negative] and continuous [distance to the margin in millimeters] variable) and other clinicopathologic parameters were compared across the 3 groups and correlated with LR. Local recurrence. Age, sex, pT stage, lymphovascular or perineural invasion, and adjuvant radiation treatment were similar across the 3 groups. The probability of LR-free survival at 3 years was 0.9 and 0.8 in groups 1 and 3, respectively (P = .03). The frequency of positive glossectomy margins was lowest in group 1 (9 of 117 [7.7%]) compared with groups 2 and 3 (28 of 61 [45.9%] and 23 of 95 [24.2%], respectively) (P < .001). Even after excluding cases with positive margins, the median distance to the closest margin was significantly narrower in group 3 (2 mm) compared with group 1 (3 mm) (P = .008). The status (positive vs negative) of margins obtained from the glossectomy specimen correlated with LR (P = .007), while the status of tumor bed margins did not. The status of the tumor bed margin was 24% sensitive (95% CI, 16%-34%) and 92% specific (95% CI, 85%-97%) for detecting a positive glossectomy margin. The margin sampling technique affects local control in patients with oral tongue SCC. Reliance on margin sampling from the tumor bed is associated with worse local control, most likely owing to narrower margin clearance and greater incidence of positive margins. A resection specimen–based margin assessment is recommended.