Impact of surgical margins status on survival outcomes in oral cavity squamous cell carcinoma: a systematic review and meta-analysis

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Objective: The aim of this study is to analyse the impact of surgical margins on survival outcomes for patients with oral cavity squamous cell carcinoma (OCSCC). Methods: Pooled hazard ratios (HRs) and 95% confidence interval (CI) were calculated to define the impact of positive and close margins on overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). Results: A total of 14 studies enrolling 4839 patients (of whom 3837 males, or 79.3%), with a median age of 59 years, were included. The incidence of positive margins was 9.1%, while that of close margins was 27.3%. The estimated pooled HRs for patients with positive surgical margins were 2.265 (95% CI: 1.431-3.584; p = 0.003) for OS, 2.076 (95% CI: 1.652-2.608; p < 0.001) for DFS, and 2.163 (95% CI: 1.349-3.468; p = 0.014) for DSS. For patients with close margins, the HRs were 1.409 (95% CI: 1.064-1.866; p = 0.024) for OS, 1.775 (95% CI: 0.910-3.462; p = 0.078) for DFS, and 1.123 (95% CI: 0.425-2.974; p = 0.658) for DSS. Conclusions: Positive surgical margins are a significant prognostic factor in OCSCC. Further studies are required to better define the impact of close margins.