國家衛生研究院 NHRI:Item 3990099045/14734
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    題名: Optimizing margin status for improving prognosis in patients with oral cavity squamous cell carcinoma: A retrospective study from the two highest-volume Taiwanese hospitals
    作者: Liao, CT;Lee, LY;Lee, SR;Ng, SH;Liu, TW;Chien, CY;Lin, JC;Wang, CP;Terng, SD;Hua, CH;Chen, TM;Chen, WC;Tsai, YT;Kang, CJ;Tsai, CY;Chu, YH;Lin, CY;Fan, KH;Wang, HM;Hsieh, CH;Yeh, CH;Lin, CH;Tsao, CK;Yen, TC;Cheng, NM;Fang, TJ;Huang, SF;Lee, LA;Fang, KH;Wang, YC;Lin, WN;Hsin, LJ;Wen, YW
    貢獻者: National Institute of Cancer Research
    摘要: BackgroundIn the treatment of oral cavity squamous cell carcinoma (OCSCC), surgical quality measures which are expected to affect outcomes, including the achievement of a clear margin, are surgeon-dependent but might not be invariably associated with hospital volume. Our objective was to explore surgical margin variations and survival differences of OCSCC between two highest-volume hospitals in Taiwan. Materials and methodsA total of 2009 and 1019 patients with OCSCC who were treated at the two highest-volume Taiwanese hospitals (termed Hospital 1 and Hospital 2, respectively) were included. We examined how a pathological margin <5 mm impacted patient outcomes before and after propensity score (PS) matching. ResultsThe prevalence of margins <5 mm was markedly lower in Hospital 1 than in Hospital 2 (34.5%/65.2%, p<0.0001). Compared with Hospital 2, tumor severity was higher in Hospital 1. On univariable analysis, being treated in Hospital 2 (versus Hospital 1; hazard ratio [HR] for 5-year disease-specific survival [DSS] = 1.34, p=0.0002; HR for 5-year overall survival [OS] = 1.17, p=0.0271) and margins <5 mm (versus >= 5 mm; HR for 5-year DSS = 1.63, p<0.0001; HR for 5-year OS = 1.48, p<0.0001) were identified as adverse factors. The associations of treatment in Hospital 2 and margins <5 mm with less favorable outcomes remained significant after adjustment for potential confounders in multivariable analyses, as well as in the PS-matched cohort. The 5-year survival differences between patients operated in Hospital 1 and Hospital 2 were even more pronounced in the PS-matched cohort (before PS matching: DSS, 79%/74%, p=0.0002; OS, 71%/68%, p=0.0269; after PS matching: DSS, 84%/72%, p<0.0001; OS, 75%/66%, p<0.0001). In the entire cohort, the rate of adjuvant therapy was found to be lower in patients with margins >= 5 mm than in those with margins <5 mm (42.7%/57.0%, p<0.0001). ConclusionsWithin the two highest-volume hospitals in Taiwan, patients with OCSCC with a clear margin status (>= 5 mm) achieved more favorable outcomes. These results have clinical implications and show how initiatives aimed at improving the margin quality can translate in better outcomes. A clear margin status can reduce the need for adjuvant therapy, ultimately improving quality of life.
    日期: 2022-11-14
    關聯: Frontiers in Oncology. 2022 Nov 14;12:Article number 1019555.
    Link to: http://dx.doi.org/10.3389/fonc.2022.1019555
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=2234-943X&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000890895900001
    Cited Times(Scopus): https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85142619884
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