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

Abstract

Objective: 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 trends and predictors in positive surgical margins (PSM) for OPSCC and OCSCC using the National Cancer Database (NCDB).

Study design: Retrospective Cohort Study.

Setting: National Cancer Database.

Methods: Retrospective analysis of patients with OCC and OPC between 2004 and 2020 in the NCDB. Linear regression analysis between PSM rates and year was performed. Multivariable logistic regression was used to investigate the effect of the year of diagnosis on PSM after adjusting for patient, tumor, and healthcare system-related factors.

Results: We analyzed 60,695 patients with OCC and 31,950 patients with OPC. Overall PSM rate was 16.1% in OCC and 33.1% in OPC. OCC PSM rate decreased from 17.7% in 2004 to 15.8% in 2020. OPC PSM rate decreased from 32.5% to 25.0%. Later date of diagnosis was associated with a reduction in positive margins for both OCC (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.99-1.0, P < .001) and OPC (0.99, 0.98-0.99, P < .001). For patients with available minimally-invasive surgery data, both later year of diagnosis (0.95, 0.93-0.96, P < .001) and use of minimally-invasive techniques (0.830, 0.75-0.92, P < .001) were associated with a reduction in PSM in OPC.

Conclusion: Positive margins for OCC/OPC have been decreasing over the past 2 decades. Robot use has been associated with a reduced PSM rate in OPC. Understanding factors that may contribute to trends in PSM is important in promoting continued improvement.