Oral oncology · 2026
Treatment of early-stage oral cavity squamous cell carcinoma at low-volume facilities impacts surgical margins and survival: an analysis of 22,258 patients from the NCDB.
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Useche Mateo, Norouzi Armita, Liao Jay J, Panjwani Neil, Laramore George E, Shih Lauren, Rodriguez Cristina P, Futran Neal, Marchiano Emily, Ferrandino Rocco, Barber Brittany
Аннотация
BACKGROUND: Positive surgical margins (PSMs) persist in many patients, even in early-stage oral cavity squamous cell carcinoma (ES-OCSCC), impacting recurrence rates and overall survival (OS). While high-volume facilities (HVFs) enhance surgical outcomes, their survival benefit in ES-OCSCC has not been assessed in an updated large cohort. The role of social determinants of health (SDOH) in predicting survival in this context is not well described.
METHODS: This retrospective cohort study analyzed stage I and II OCSCC patients from the National Cancer Database between 2004 and 2020. Facilities were categorized by case volume into low-(<2 cases/year), medium-(2-10), and high-volume (>10). Hazards ratios estimated the impact of facility volume on OS, adjusting for clinical/surgical factors, and SDOH. Kaplan-Meier survival curves compared OS.
RESULTS: Among 22,258 patients with ES-OSCC, 42.55% were treated at HVFs. PSMs rates were higher at LVFs (T1: 7.16%, T2: 13.63%) and MVFs (T1: 4.33%, T2: 7.56%) compared with HVFs (T1: 2.89%, T2: 4.74%). Treatment at LVFs was associated with higher odds of PSMs (OR = 2.8; 95% CI: 2.34-3.37, p < 0.001). Five-year OS was highest at HVFs (80.2%), followed by MVFs (77.1%) and LVFs (70.9%, p < 0.001). Survival remained worse at LVF/MVFs among those with negative surgical margins (NSMs) or PSMs receiving RT/CRT. SDOH, including government insurance (OR = 2.05; 95% CI: 1.27-3.17, p = 0.002) and proximity to treatment facility (OR = 1.28; 95% CI: 1.06-1.56, p = 0.01) increased PSM risk, while higher income (OR = 0.76; 95% CI: 0.6-0.97, p = 0.03) was protective.
CONCLUSIONS: Facility volume and SDOH influence PSM rates and OS in ES-OCSCC. Patients treated at HVFs experienced better outcomes, emphasizing the need for improved surgical quality metrics and centralization of care, even for ES-OCSCC.
METHODS: This retrospective cohort study analyzed stage I and II OCSCC patients from the National Cancer Database between 2004 and 2020. Facilities were categorized by case volume into low-(<2 cases/year), medium-(2-10), and high-volume (>10). Hazards ratios estimated the impact of facility volume on OS, adjusting for clinical/surgical factors, and SDOH. Kaplan-Meier survival curves compared OS.
RESULTS: Among 22,258 patients with ES-OSCC, 42.55% were treated at HVFs. PSMs rates were higher at LVFs (T1: 7.16%, T2: 13.63%) and MVFs (T1: 4.33%, T2: 7.56%) compared with HVFs (T1: 2.89%, T2: 4.74%). Treatment at LVFs was associated with higher odds of PSMs (OR = 2.8; 95% CI: 2.34-3.37, p < 0.001). Five-year OS was highest at HVFs (80.2%), followed by MVFs (77.1%) and LVFs (70.9%, p < 0.001). Survival remained worse at LVF/MVFs among those with negative surgical margins (NSMs) or PSMs receiving RT/CRT. SDOH, including government insurance (OR = 2.05; 95% CI: 1.27-3.17, p = 0.002) and proximity to treatment facility (OR = 1.28; 95% CI: 1.06-1.56, p = 0.01) increased PSM risk, while higher income (OR = 0.76; 95% CI: 0.6-0.97, p = 0.03) was protective.
CONCLUSIONS: Facility volume and SDOH influence PSM rates and OS in ES-OCSCC. Patients treated at HVFs experienced better outcomes, emphasizing the need for improved surgical quality metrics and centralization of care, even for ES-OCSCC.