title: How does the close surgical margin impact recurrence and survival when treating oral squamous cell carcinoma?
abstract: OBJECTIVE
  The surgical margin is the main prognostic factor over which the surgeon has control during resection of oral squamous cell carcinoma (OSCC). This study examined the association between surgical excision margins of patients with OSCC and outcomes of disease-free and overall survival.
  
  
  METHODS
  The authors implemented a retrospective cohort study. The sample was composed of patients with OSCC having resection as their initial treatment. The predictor variable was the pathologic surgical margin, defined as clear (>5 mm), close (1 to 5 mm), or involved (<1 mm). The outcome variables were disease-free (absence of locoregional recurrence) and overall survival. Data were analyzed using Kaplan-Meier survival curves and Cox regression hazard model.
  
  
  RESULTS
  The sample was composed of 54 patients with a mean age of 60.5 years (range, 19 to 85 yr) and 26% were women. The 2- and 5-year overall survival rates were 59 and 50%, respectively. The clear surgical margin group showed higher disease-free survival rates than patients with close and involved margins (5-yr probability, 0.78 vs 0.43 and 0.29; P = .014) and a trend toward increased overall survival at 2 and 5 years (P = .093).
  
  
  CONCLUSIONS
  The results suggest that the presence of a close surgical margin (1 to 5 mm) is an adverse risk feature comparable to an involved margin and therefore is associated with decreased disease-free and overall survival. Future studies are needed to replicate these findings before they can be used as a basis for clinical recommendations.
authors: Attending, Department of Oral and Maxillofacial Surgery, Harborview Medical Center, University of Washington, Seattle, WA. Electronic address: dillonj5@uw.edu.
authors: Jasjit K
authors: JK
authors: Dillon
authors: Resident, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA.
authors: Christopher B
authors: CB
authors: Brown
authors: Resident, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA.
authors: Tyler M
authors: TM
authors: McDonald
authors: Dental Student, School of Dentistry, University of Washington, Seattle, WA.
authors: David C
authors: DC
authors: Ludwig
authors: Dental Student, School of Dentistry, University of Washington, Seattle, WA.
authors: Patrick J
authors: PJ
authors: Clark
authors: Professor, Department of Biostatistics and Department of Oral Health Sciences, University of Washington, Seattle, WA.
authors: Brian G
authors: BG
authors: Leroux
authors: Professor and Chairman, Department of Otolaryngology, Head and Neck Surgery, University of Washington, Seattle, WA.
authors: Neal D
authors: ND
authors: Futran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult