title: Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck.
abstract: OBJECTIVE
  The purpose of this study was to analyse the impact of surgical margins on tumour recurrence and survival of patients with carcinomas of the head and neck.
  
  
  METHODS
  A cohort of 156 patients with primary squamous cell carcinoma of the head and neck treated by local resection with negative margins and neck dissection between 2004 and 2012 was investigated. Margin status in frozen sections and permanent paraffin tissues were analysed and compared to clinical and histopathological parameters as well as to tumour recurrence (local, regional and distant) and disease-specific survival (DSS).
  
  
  RESULTS
  Close margins (<5mm) on permanent sections were correlated to high-grade differentiation (p=0.070), lymphangiosis (p=0.009) and positive neck nodes (p=0.025) implicating regional and distant recurrence (p=0.001) as well as unfavorable DSS (p=0.002). Positive margins on initial frozen section analysis revised into negative margins during further surgery were the strongest predictor for local recurrence in uni- and multivariate analysis (p<0.001, hazard ratio 3.34). However, positive frozen section margins were not significantly predictive for DSS (p=0.150). Significant predictors for DSS in univariate analysis were local recurrence (p=0.026), T-stage (p=0.02), N-stage (p<0.001), grading (p=0.02) and lymphangiosis (p=0.001). Multivariate DSS analysis revealed lymph node metastasis (p=0.005) and local recurrence (p=0.017) as significant negative predictors.
  
  
  CONCLUSIONS
  Close margins on permanent sections are associated with aggressive tumour characteristics, regional and distant metastasis implicating worse DSS. The accuracy of frozen section analysis seems limited as positive frozen section margins revised into negative margins bear a high risk of local recurrence.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: tobias.ettl@ukr.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Ettl
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: alainel-gindi@gmx.de.
authors.forename: Alain
authors.initials: A
authors.lastname: El-Gindi
authors.affiliation: Department of Radiotherapy, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: matthias.hautmann@ukr.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hautmann
authors.affiliation: Department of Oral and Maxillofacial Surgery, Nuremberg Hospital, Breslauer Straße 201, 90471 Nürnberg, Germany. Electronic address: martin.gosau@ukr.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Gosau
authors.affiliation: Institute of Pathology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: florian.weber@ukr.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Weber
authors.affiliation: Department of Otorhinolaryngology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: christian.rohrmeier@ukr.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Rohrmeier
authors.affiliation: Center of Tumor Registry, University of Regensburg, Regensburg, Germany. Electronic address: michael.gerken@ukr.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Gerken
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: steffen.mueller@ukr.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Müller
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: torsten.reichert@ukr.de.
authors.forename: Torsten
authors.initials: T
authors.lastname: Reichert
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: christoph.klingelhoeffer@ukr.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Klingelhöffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D005629:Frozen Sections; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis
keywords: Frozen section; Head neck cancer; Local recurrence; Surgical margin; Survival