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.

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.