正常的舌癌，立即切除阳性边缘可以改善局部控制。
Immediate resection of positive margins improves local control in oral tongue cancer.
发表日期：2023 Apr 22
作者：
Lisa Zhang, Ryan T Judd, Songzhu Zhao, Chandler Rygalski, Michael Li, Ashleigh Briody, Brian Swendseid, Dukagjin M Blakaj, Amit Agrawal, Enver Ozer, Ricardo L Carrau, Theodoros N Teknos, Kyle VanKoevering, James W Rocco, Matthew O Old, Nolan B Seim, Sidharth V Puram, Catherine T Haring, Stephen Y Kang
来源：
ORAL ONCOLOGY
摘要：
本研究旨在调查即刻切除阳性切缘对口腔舌癌局部控制的影响。我们分析了2013年至2018年连续切除的273例口腔舌癌。在初始手术过程中，根据外科医生对样本和/或冰冻边缘的检查，对病例进行了额外的切除。阳性切缘被定义为距离标记边缘<1 mm处的浸润性癌症/高级别上皮内瘤变。将患者分为以下三组：阴性切缘组（第1组），阳性切缘且立即进行额外组织切除组（第2组），阳性切缘但没有额外组织切除组（第3组）。总体而言，局部复发率为7.7％（21/273），主标本阳性率为17.9％。在这些患者中，38.8％（19/49）的患者进行了即刻治疗预测阳性切缘的额外切除。经T分期调整后，与第1组相比，第3组的局部复发率更高（aHR 2.8 [95％ CI 1.0-7.7]，p=0.04）。第2组的局部复发率类似（aHR 0.45 [95％ CI 0.06-3.6]，p=0.45）。第1组、第2组和第3组的3年局部复发自由生存率分别为91％、92％和73％。与主标本边缘相比，术中冰冻瘤床边缘的敏感性为17.4％，特异性为95％。在主标本边缘阳性的患者中，即刻切除预测阳性切缘的额外组织切除能够降低局部复发率，使其类似于主标本阴性患者的复发率。这些发现支持使用技术提供实时术中边缘数据并指导额外切除以改善局部控制。版权所有©2023 Elsevier Ltd.
This study investigates the impact of immediate resection of positive margins on local control of oral tongue cancer.We analyzed 273 consecutive oral tongue cancers resected from 2013 to 2018. Additional resection was performed in cases during the initial operation based on surgeon inspection of the specimen and/or frozen margins. Positive margins were defined as invasive carcinoma/high-grade dysplasia < 1 mm from the inked edge. Patients were grouped as follows: negative margin (Group 1); positive margin with immediate additional tissue resection (Group 2); and positive margin without additional tissue resection (Group 3).Overall, the rate of local recurrence was 7.7 % (21/273), and the rate of positive main specimen margin was 17.9 %. Of these patients, 38.8 % (19/49) underwent immediate additional resection of the presumed positive margin. Group 3 had higher local recurrence rates than Group 1 after adjustment for T-stage (aHR 2.8 [95 % CI 1.0-7.7], p = 0.04). Group 2 had similar rates of local recurrence (aHR 0.45 [95 % CI 0.06-3.6], p = 0.45). Three year local recurrence free survival for Groups 1, 2, and 3 were 91 %, 92 % and 73 %, respectively. Compared to the main specimen margin, sensitivity of intraoperative frozen tumor bed margins was 17.4 %, and specificity was 95 %.In patients with positive main specimen margins, anticipation and detection in real-time with immediate additional tissue resection reduced local recurrence to rates similar to those with negative main specimen margins. These findings support the use of technology to provide real-time intraoperative margin data and guide additional resection for improved local control.Copyright © 2023 Elsevier Ltd. All rights reserved.