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Program Number: B228
Session Name: Poster Session

Specimen-driven margins improve disease-free and overall survival for oral cavity and oropharyngeal squamous cell carcinoma

Kelly M Bridgham, MD¹; Hannah Kenny, MD¹; Jennifer Goldfarb, BS¹; Sonali Prasaud¹; Praneet Kaki, BS¹; Annie Moroco, MD¹; Michael Topf, MD²; David Cognetti, MD¹; Adam Luginbuhl, MD¹; Joseph Curry, MD¹; ¹Thomas Jefferson University Hospital; ²Vanderbilt University Medical Center

Introduction: Approach to margin-assessment in head and neck squamous cell carcinoma (HNSCC) remains a controversial topic. Specimen-driven intraoperative margin sampling is often considered superior to defect-driven margin sampling. However, the impact of specimen-driven approaches on recurrence-free survival and overall survival remains unclear. The purpose of this study is to evaluate the association between margin assessment method and survival outcomes in oral cavity (OC) and oropharyngeal (OP) HNSCC.

Methods: A retrospective review was performed, including all patients at a single institution with OC or OP HNSCC who underwent surgical resection between 2018 and 2024 and had sufficient follow-up for evaluation of survival. Operative records and pathology reports were reviewed to determine whether surgeons utilized specimen-driven or defect-driven margins for intraoperative pathologic analysis. Primary outcomes were 3-year disease free (DFS) and overall survival (OS). Secondary outcomes included rates of close or positive initial margins that required re-resection, final positive margins, and adverse pathologic features. Descriptive statistics using Wilcoxon rank sum and Pearson chi-square tests were performed to compare demographic and tumor-related factors between the specimen and defect-driven cohorts. Kaplan-Meier curves were generated to assess the impact of the method of margin sampling on survival outcomes.

Results: Of the 608 patients identified, 107 (17.6%) and 501 (82.4%) underwent defect-driven and specimen-driven margin assessment, respectively. A higher percentage of patients with OC SCC (73% vs 39%, p<0.001), T4 disease (34% vs. 12%, p<0.001), and HPV negative tumors (60% vs 27%, p<0.001) required defect-driven margins. There were no significant differences in the rates of initially close or positive margins, re-resection, or final positive margins between the two methods. Defect-driven margins were more commonly associated with adverse pathologic features including lymphovascular and/or perineural invasion (68% vs. 52%, p<0.001). Kaplan-Meier analysis showed a trend towards improved 3-year DFS (Figure 1, p=0.00047) and OS (Figure 2, p=0.00064) for specimen-driven margin sampling as compared to defect-driven sampling.

Discussion: At our institution, surgeons more commonly utilize specimen-driven approaches for intraoperative margin assessment. Specimen-driven approaches might not always be feasible for patients with more advanced or aggressive tumors based on the characteristics more commonly represented among the defect-driven cohort in our study. There is a trend towards improved disease-free and overall survival using specimen-driven approaches. Further studies are needed to discern the relationship between margin-assessment methodology and survival outcomes, and to determine if this association remains while controlling for factors associated with more aggressive or advanced disease.

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Figure 2.

 

 

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