ON THE EDGE: EVALUATING CLINICOPATHOLOGICAL OUTCOMES OF PATIENTS WITH CLOSE AND INVOLVED SURGICAL RESECTION MARGINS IN EARLY-STAGE TONGUE SQUAMOUS CELL CARCINOMA

Abstract

Background: Early-stage oral tongue cancers, predominantly squamous cell carcinomas, originate in the anterior two-thirds of the tongue. Surgical resection remains the cornerstone of treatment, aiming to excise the tumour along with a margin of healthy tissue. Ensuring clear surgical margins is essential, as it substantially influences prognosis by minimizing the likelihood of local recurrence and enhancing overall survival rates.

Objectives: This study examines the outcomes of early-stage squamous cell carcinoma of the oral tongue with close and involved surgical resection margins, focusing on recurrence rates, survival outcomes, and the necessity for adjuvant treatment.

Materials and Methods: This retrospective cohort study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan from January 1, 2011, to December 30, 2021. A total of 158 patients, aged 18 to 75 years, diagnosed with early-stage oral tongue cancer (stages I and II) were included through consecutive sampling. Patients with metastatic disease, prior head and neck cancers, concurrent malignancies, or significant comorbidities that could affect treatment or prognosis were excluded. Data analysis was performed using SPSS Statistics 27, and Kaplan-Meier analysis was employed to evaluate overall and recurrence-free survival.

Results: Among the n=158 patients, n=123 (77.8%) had close margins, n=35 (22.2%) had involved margins. Males were the majority in both groups (p=0.846). The estimated mean survival time was 110.04 ± 9.92 months for patients with close margins and 69.94 ± 2.03 months for those with involved margins. Patients with involved margins exhibited a lower mean survival time (p=0.394). The overall 5-year survival rates were approximately 89.20% (95% CI: 79.60%-99.90%) for close margins and 96.9% (95% CI: 91.00%-100%) for involved margins. The estimated recurrence-free mean survival time was 93.33 ± 10.36 months for close margins and 54.97 ± 4.65 months for involved margins (p=0.549). The 5-year recurrence-free survival rate was 73.90% (95% CI: 91.90%-89.30%) for close margins and 58.9% (95% CI: 38.30%-90.60%) for involved margins.

Conclusion: This study evaluated the outcomes of early-stage oral tongue squamous cell carcinoma (SCC) with close and involved surgical resection margins. The results indicate that patients with involved margins experienced lower mean survival times and higher recurrence rates, although these differences were not statistically significant. The study underscores the critical importance of precise margin assessment during surgery, as margin status can significantly impact survival and recurrence rates. The high overall and recurrence-free survival rates observed reflect effective management strategies, highlighting the potential role of adjuvant treatment decisions based on margin status. These findings contribute to refining treatment approaches and optimizing outcomes for patients with early-stage oral tongue SCC.