Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence

Between August 2000 and June 2008, a total of 110 patients with buccal mucosa carcinoma (25 with stage I, 31 with stage II, 11 with stage III, and 43 with Stage IV classified according to the American Joint Committee on Cancer 6th edition) were treated with surgery alone (n = 32), surgery plus postoperative radiotherapy (n = 38) or surgery plus adjuvant concurrent chemoradiotherapy (n = 40).Main outcome measures: The primary endpoint was locoregional disease control.The median follow-up time at analysis was 25 months (range, 4-104 months). The 3-year locoregional control rates were significantly different when a 3-mm surgical margin (≤3 versus >3 mm, 71% versus 95%, p = 0.04) but not a 5-mm margin (75% versus 92%, p = 0.22) was used as the cut-off level. We also found a quantitative correlation between surgical margin and locoregional failure (hazard ratio, 2.16; 95% confidence interval, 1.14 - 4.11; p = 0.019). Multivariate analysis identified pN classification and surgical margin as independent factors affecting disease-free survival and locoregional control.Narrow surgical margin ≤3 mm, but not 5 mm, is associated with high risk for locoregional recurrence of buccal mucosa carcinoma. More aggressive treatment after surgery is suggested.The incidence of buccal mucosa carcinoma has rapidly increased in Taiwan in recent decades; major risk factors for this disease are smoking, alcohol drinking, and betel nut chewing[1-3]. In patients with buccal mucosa carcinoma, locoregional recurrence (rate, 30-80%) is the main cause of treatment failure[4,5]. Several predictive factors for locoregional recurrence have been reported: bone erosion or invasion, positive surgical margin, perineural infiltration or invasion, vascular invasion, lymph node involvement, and extracapsular extension of tumor from the involved lymph node[6].To reduce the risk of locoregional recurrence, radical surgery plus postoperative radiotherapy (RT) has been recommended for locoreginally advanced dise