A very close margin of ≤1 mm predicts a poor outcome in resected buccal cancer patients with a pathological margin of ≤3 mm

Wei-Ta Tsai^a, Moon-Sing Lee^{a, b}, Shih-Kai Hung^{a, b}, Wen-Yen Chiou^{a, b}, Tze-Ta Huang^{b, c}, Chih-En Tseng^{b, d}, Shu-Mei Chang^{b, d}, Feng-Chun Hsu^a, Yu-Chieh Su^{b, e}, Szu-Chi Li^{b, e}, Wen-Lin Hsu^{b, f}, Dai-Wei Liu^{b, f,} Hon-Yi Lin^{a, b, g}

^a Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^b School of Medicine, Tzu Chi University, Hualien, Taiwan
^c Department of Dental Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^d Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^e Department of Hematology-Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^f Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^g Institute of Molecular Biology, National Chung Cheng University, Chiayi, Taiwan

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Abstract
Objectives

A close margin of ≤3 mm results in a high risk for locoregional recurrence, but still is not an independent factor that helps to guide the use of aggressive postoperative therapies in patients with resected buccal mucosa carcinoma. This suggests there is a diversity of clinical outcomes in this group of patients. The present study explores the predictors among this clinically debated group of patients.

Materials and Methods

From 2000 to 2008, 30 resected buccal mucosa carcinoma patients with a close margin of ≤3 mm were retrospectively included in this study. All patients were treated with radical surgery together with postoperative radiotherapy (RT) or chemoradiotherapy (CCRT). Locoregional/local/regional control, disease-free status, disease-specific survival and overall survival were the study end points.

Results

Two factors were observed that were able to predict 5-year locoregional control. These were a pathological N classification (pN0 vs. pN1-2, 71.5% vs. 30.0%, p = 0.044) and a very close margin (> 1 mm vs. ≤1 mm, 81.8% vs. 50.7%, p = 0.040). Remarkably, the predicting effect of a very close margin was well translated into disease-free status (81.8% vs. 47.1%, p = 0.024) and disease-specific survival (100% vs. 70.6%, p = 0.037). After multivariate analysis, a very close margin of ≤1 mm was found to independently predict a high risk of locoregional recurrence (HR, 9.528; 95% CI, 1.326–18.481; p = 0.025) and disease failure at any site (HR, 12.778; 95% CI, 1.934–25.217; p = 0.013).

Conclusion

More aggressive postoperative treatments should be considered for resected buccal mucosa carcinoma patients with a very close margin of ≤1 mm.

Keywords
Buccal mucosa carcinoma; Chemoradiotherapy; Close margin; Locoregional control; Radiotherapy