Impact of surgical margins on recurrence and survival rate in patients with oral squamous cell carcinoma: A systematic review and meta-analysis

TL;DR

This study finds that achieving a 5mm tumor-free surgical margin significantly reduces recurrence and improves survival in oral cancer patients.

Contribution

The study provides a meta-analysis confirming 5mm as the optimal surgical margin for oral squamous cell carcinoma.

Findings

Positive margins (<5mm) increase local recurrence risk by 2.72 times.

Negative margins (5mm) improve 5-year survival by 1.58 times.

Surgical margin status is a key prognostic factor for oral cancer outcomes.

Abstract

Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of malignant neoplasms of the oral cavity. At early stages, the treatment of choice is surgical resection with clear margins, commonly defined as 5mm of tumor-free tissue. However, the optimal surgical margin in relation to recurrence and survival remains controversial. The objective of this study was to evaluate the impact of surgical margin status on local recurrence and overall survival in patients with OSCC through a meta-analysis.

An electronic search was conducted in Medline-PubMed, Web of Science, and Scopus up to January 2025. Two investigators independently selected the studies according to the inclusion criteria. The study included prospective and retrospective studies assessing patients with oral squamous cell carcinoma who underwent surgical treatment and reported data regarding surgical margin status, recurrence rates, and survival outcomes. The Newcastle-Ottawa Scale was used for non-randomized observational studies. Odds ratios were estimated with 95% confidence intervals, and forest plots were generated using random-effects or fixed-effects meta-analyses depending on heterogeneity. Sensitivity analyses and publication bias analyses were performed using funnel plots and Egger's test. All statistical analyses were conducted using Comprehensive Meta-Analysis software, version 3.0.

Positive margins (<5mm) were significantly associated with a higher rate of local recurrence (OR=2.72; 95% CI: 2.04-3.62; p<0.001), while negative margins (5mm) were linked to a 1.58 -fold increase in the probability of 5-year survival (RR=0.63; 95% CI: 0.55-0.74; p<0.001).

Surgical margin status is a prognostic factor for locoregional control and overall survival in OSCC. A cutoff value of 5mm is proposed as the optimal surgical margin.

Figures