Should sub-millimeter margins be deemed positive in oral cavity squamous cell carcinoma?

Chung Jan Kang, Li Yu Lee, Shu Hang Ng, Chien Yu Lin, Kang Hsing Fan, Wen-Cheng Chen, Jin Ching Lin, Yao Te Tsai, Shu Ru Lee, Chih Yen Chien, Chun Hung Hua, Cheng Ping Wang, Tsung Ming Chen, Shyuang Der Terng, Chi Ying Tsai, Hung Ming Wang, Chia Hsun Hsieh, Chih Hua Yeh, Chih Hung Lin, Chung Kan TsaoNai Ming Cheng, Tuan-Jen Fang, Shiang Fu Huang, Li Ang Lee, Ku Hao Fang, Yu Chien Wang, Wan Ni Lin, Li Jen Hsin, Tzue-Chen Yen, Yu Wen Wen*, Chun Ta Liao

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review


BACKGROUND: While several studies have indicated that a margin status of < 1 mm should be classified as a positive margin in oral cavity squamous cell carcinoma (OCSCC), there is a lack of extensive cohort studies comparing the clinical outcomes between patients with positive margins and margins < 1 mm.

METHODS: Between 2011 and 2020, we identified 18,416 Taiwanese OCSCC patients who underwent tumor resection and neck dissection. Of these, 311 had margins < 1 mm and 1013 had positive margins. To compare patients with margins < 1 mm and those with positive margins, a propensity score (PS)-matched analysis (n = 253 in each group) was conducted.

RESULTS: The group with margins < 1 mm displayed a notably higher prevalence of several variables: 1) tongue subsite, 2) younger age, 3) smaller depth of invasion), 4) early tumor stage, and 5) treatment with surgery alone. Patients with margins < 1 mm demonstrated significantly better disease-specific survival (DSS) and overall survival (OS) rates compared to those with positive margins (74 % versus 53 %, 65 % versus 43 %, both p < 0.0001). Multivariable analysis further confirmed that positive margins were an independent predictor of worse 5-year DSS (hazard ratio [HR] = 1.38, p = 0.0103) and OS (HR = 1.28, p = 0.0222). In the PS-matched cohort, the 5-year outcomes for patients with margins < 1 mm compared to positive margins were as follows: DSS, 71 % versus 59 %, respectively (p = 0.0127) and OS, 60 % versus 48 %, respectively (p = 0.0398).

CONCLUSIONS: OCSCC patients with a margin status < 1 mm exhibited distinct clinicopathological characteristics and a more favorable prognosis compared to those with positive resection margins.

Original languageEnglish
Article number106745
Pages (from-to)106745
JournalOral Oncology
StatePublished - 04 2024

Bibliographical note

Copyright © 2024. Published by Elsevier Ltd.


  • Cancer registry
  • Clinical outcomes
  • Oral cavity squamous cell carcinoma
  • Positive margins
  • Resection margins
  • Prognosis
  • Humans
  • Child, Preschool
  • Squamous Cell Carcinoma of Head and Neck/pathology
  • Carcinoma, Squamous Cell/pathology
  • Mouth Neoplasms/pathology
  • Retrospective Studies
  • Neoplasm Staging
  • Head and Neck Neoplasms/pathology


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