Positive Margin Rates in Oral Cavity and Oropharyngeal Malignancies: A National Analysis

Monday, September 30, 2024

3:00 PM – 3:06 PM EDT

Location: MBCC, 208

Disclosure(s):

Antoinette R. Esce, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael C. Topf, MD, MSCI:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Oral cavity malignancies (OCC) and oropharyngeal malignancies (OPC) historically have higher rates of positive surgical margins (PSM) compared to other solid malignancies. The objective of this study is to understand recent trends and predictors in positive surgical margins for OPSCC and OCSCC over the past 17 years.

Methods: A retrospective analysis of patients with OCC and OPC in the recently updated National Cancer Database (NCDB) between 2004-2020 was conducted. Robotic/minimally invasive surgery utilization for OP was only available for patients diagnosed in 2010 or later. Linear regression between PSM rates and year was performed. Multivariable logistic regression predicting PSM was used to investigate the adjusted effect of year of diagnosis on PSM after adjusting for patient-related factors, tumor-related/surgical factors, and healthcare system covariates.

Results: We analyzed 172,679 patients with OCC and 28,760 patients with OPC who met inclusion criteria. The overall PSM rate during the study period was 17% in OCC and 24.2% in OPC. Of OPC patients (N = 17,322) with known robotic/open approaches for surgery, 47.5% (N = 8235) underwent minimally invasive or robotic surgery. Rates of robotic surgery increased from 32.3% in 2010 to 52.9% in 2020. On univariate linear regression analysis, PSM in both OPC (beta -94, 95% CI -108 - -80, p < 0.001) and OCC (beta -15, -24 - -6.1, p = 0.003) decreased over the study period. On multivariate logistic regression analysis, the year of diagnosis was independently associated with PSM for OC (OR 0.988, 95%CI 0.98-0.99, p < 0.001) and OP (OR 0.961, 0.954-0.966, p < 0.001). For patients diagnosed in 2010+ with available robotic surgery data, both year of diagnosis (OR 0.952, 95% CI 0.939-0.975, p < 0.001) and use of robotic/minimally invasive techniques (OR 0.808, 95%CI 0.738-0.878, p < 0.001) were independently associated with a reduction in PSM in OPC.

Conclusions: PSM remains high for OC and OPC. Robot use has been associated with a reduced PSM rate in OPC. Understanding factors that may contribute to decreasing trends in PSM is important in promoting continued improvement.

Presenting Author(s)

Rahul Kamal Sharma, MD

Resident Physician
Vanderbilt University Medical Ctr
Nashville, Tennessee, United States

Disclosure information not submitted.

Co-Author(s)

RO

Ryan Orosco, MD

University of New Mexico Medical Center, United States

Disclosure information not submitted.
Ramez Phillips, MD

Medical Student
Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
Farhoud Faraji, MD

Resident Physician
UC San Diego Department of Otolaryngology
La Jolla, CA, United States

Disclosure information not submitted.
Antoinette R. Esce, MD

Fellow
Icahn School of Medicine at Mount Sinai
Albuquerque, NM, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

MT

Michael C. Topf, MD, MSCI

Assistant Professor of Otolaryngology - Head and Neck Surgery
Vanderbilt University Medical Center
Nashville, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.