The Impact of Stratified Surgical Margins on Survival Outcomes in Oral Cavity Squamous Cell Carcinoma: A Multicenter Analysis

Abstract

Background: This multicenter study examines the impact of stratified surgical margins on treatment outcomes in oral SCC. Methods: Margins were stratified into 1 mm increments from 0 to ≥ 5 mm. Outcomes included local recurrence, overall and disease-specific survivals. Sub-analyses assessed the impact of margin status by risk factors, oral subsites, and peripheral versus deep margins. Results: Among 2737 patients, ≥ 2 to < 3 mm margins were associated with improved outcomes compared to 0 mm. Further benefits were observed in the ≥ 4 to < 5 mm group. The differences between these two groups were not statistically significant. Improved outcomes were observed with ≥ 2 mm deep margins, but not for peripheral margins. High-risk tumors had better overall and disease-specific survivals with ≥ 2 mm margins. Subsites of the tongue, palate, mandible, and floor of the mouth had improved local control with ≥ 2 mm margins. Conclusion: Margins beyond 4 mm do not confer additional oncological benefit, while achieving ≥ 2 mm, especially in deep margins or high-risk tumors, is critical for optimal outcomes.