Abstract
Purpose
To define if positive and close surgical margins are associated to worse prognosis
in patients who underwent transoral robotic surgery (TORS) after neoadjuvant chemotherapy
(NCT).
Methods
A retrospective cohort study was carried out at a tertiary referral center. The primary
outcome was local-regional control (LRC), and the results were summarized with hazard
ratios (HR) and 95% confidence intervals (CIs).
Results
A total of 308 patients (median age: 62.0, IQR: 55.0–68.2) were included. Univariable
analysis showed a significant reduced LRC for patients with positive margins (HR = 1.82,
95% CI: 1.02–3.24). However, they were not associated with worse LRC after adjusting
for adverse tumor variables (HR = 0.81, 95% CI: 0.40–1.65). ROC analysis was performed
on 123 patients with negative margins (AUC: 0.54) measuring an optimal threshold of
1.25 mm (sensitivity = 60.0%; specificity = 50.5%). Univariable analysis showed non-significant
differences between close and wide negative margins (HR = 1.44, 95% CI: 0.59–3.54).
Conclusions
A positive surgical margin is not an independent predictor of tumor control and survival.
A threshold of 1.25 mm was identified as the most appropriate to define close margins,
but no difference was measured after distinguishing negative margins in close and
wide margins.
Keywords
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Abbreviations
LVIlymphovascular invasion
PNIperineural invasion
ENEextranodal extension
Article info
Publication history
Published online: March 14, 2023
Accepted:
March 13,
2023
Received in revised form:
March 10,
2023
Received:
December 21,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
