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Predictors of recurrence in oral cavity cancer with clear surgical margins
Mansi Agrawal1, Vidya Konduru1, Amit Jiwan Tirkey1, Riju Jeyashant2, Philip George3, Dona Maria Philip4, Chandramohan Setty5, Kiran Kumar Devarkonda6
1 Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Head and Neck Surgery, Unit-1, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of ENT and Head and Neck Surgery, Mar Sleeva Medicity Palai, Puliyannoor, Kerala, India
4 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
5 Department of Head and Neck Surgery, Kidwai Hospital, Bengaluru, Karnataka, India
6 Department of Surgical Oncology, KIMS Hospital, Hyderabad, Telangana, India
Correspondence Address:
Dr. Vidya Konduru
Department of Head and Neck Surgery, Unit-2, 2nd Floor, Paul Brand Building, Christian Medical College Hospital Campus, Vellore - 632 004, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cmi.cmi_70_22
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Introduction: Oral cancers recur in a significant proportion of patients, in spite of aggressive treatment strategies. The presence of a clear surgical margin is an important predictor of recurrent disease, among others. Since oral cancers often recur in the absence of compromised margins, there is a need to study the factors affecting recurrence and overall survival outcomes where clear surgical margins have been achieved during upfront surgery. This study attempts to identify the significant predictors of locoregional recurrence in oral squamous cell carcinoma (OSCC) with pathologically clear surgical margins. Methodology: This retrospective study was done to study the clinicopathological parameters associated with recurrence of oral cavity squamous cell carcinoma (SCC) in patients with clear surgical margins operated in our unit between January 2010 and December 2015. A total of 526 cases of oral cavity SCC were analyzed and records of 160 cases with clear surgical margins were reviewed for clinical details, histopathological data, and follow-up status. Age, gender, subsite, T–N clinical and pathological staging, tumor depth of invasion, grade of differentiation, lymphovascular invasion, perineural spread, adjuvant therapy, and recurrence details were analyzed. Results: Lymphovascular Invasion was found to be a significant predictor for local recurrence in OSCC in both univariate and multivariate analysis. Median recurrence-free survival was 53.6 months. Conclusion: Despite the best efforts of the surgeon in obtaining adequate tumor-free margins and the most comprehensive adjuvant treatment, recurrence patterns in oral cancers continue to defy accurate prediction. Lymphovascular invasion could be an important predictor of recurrence for oral cavity cancers in patients with clear surgical margins that require aggressive management.
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