Research Progress Regarding Surgical Margins, Molecular Margins, and Prognosis of Laryngeal Carcinoma

Background: Laryngeal carcinoma is one of the most common malignant tumors of the head and neck. Researchers have refined the study of surgical margin in the anatomical subarea of the larynx to determine the most appropriate distance of the surgical margin for laryngeal carcinoma, to achieve accurate resection of laryngeal carcinoma and to improve the possibility of retention of laryngeal function. Methods: A comprehensive review of the primary literature was performed from 2009 to 2019 utilizing keywords laryngeal carcinoma, surgical margin, molecular margin, and prognostic factor. Articles were included at the discretion of the authors based on novel and/or contributions to the literature. Results: The prognosis of laryngeal carcinoma significantly correlates with the status of surgical margins. Patients with positive surgical margins have higher recurrence and metastasis rates and worse prognosis. Patients with negative pathological surgical margin but with the expression or altered expression levels of one or more tumor-related molecular biomarkers had high rates of recurrence and metastasis, and poor prognosis. Conclusions: Clinical intervention can improve the prognosis of patients with positive surgical margins. Patients with close margins should be followed closely. Among patients with negative surgical margins, patients with abnormal molecular margin results should be closely followed up. However, the specific selection of one or several molecular biomarkers as the detection index of molecular margin currently requires multicenter prospective or retrospective large sample study as guidance.

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Sarcomas of the Nasal Cavity and Paranasal Sinuses

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949410300907 ◽

1994 ◽

Vol 103 (9) ◽

pp. 699-704 ◽

Cited By ~ 22

Author(s):

Joel A. Sercarz ◽

Rufus J. Mark ◽

Ian Storper ◽

Luu Tran ◽

Thomas C. Calcaterra

Keyword(s):

Los Angeles ◽

Paranasal Sinuses ◽

Adjuvant Radiotherapy ◽

Combined Modality Therapy ◽

Surgical Margin ◽

Surgical Margins ◽

Low Grade ◽

Positive Surgical Margins ◽

Key Issues ◽

The University

Sarcomas of the nose and paranasal sinuses are rare malignancies. Key issues remain unresolved in the management of these tumors, particularly with regard to the role of radiotherapy. To help clarify these issues, 48 consecutive cases of nasal and paranasal sinus sarcomas treated at the University of California, Los Angeles, between 1958 and 1988 were retrospectively reviewed. Six of 16 patients managed initially with surgery alone were cured. All had negative surgical margins and 5 of the 6 had low-grade tumors. Of 5 patients with high-grade lesions treated with surgery only, 1 was rendered free of disease. Twelve patients with positive surgical margins were treated with adjuvant radiotherapy; 5 were cured with this approach. Grade and surgical margin status were found to be significantly related to outcome for sinonasal sarcoma. There were 14 patients with rhabdomyosarcoma; 3 were cured with modern combined-modality therapy. Patients with positive surgical margins should be treated with adjuvant radiotherapy. Surgical therapy is effective for low-grade lesions that are completely excised.

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Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience

European Surgical Research ◽

10.1159/000519718 ◽

2021 ◽

pp. 1-13

Author(s):

Mehmet Hakan Korkmaz ◽

Ömer Bayır ◽

Esra Bozkurt Hatipoğlu ◽

Emel Çadalli Tatar ◽

Ünsal Han ◽

...

Keyword(s):

Early Stage ◽

Anterior Commissure ◽

Survival Rates ◽

Surgical Margin ◽

Surgical Margins ◽

Positive Surgical Margin ◽

Single Center ◽

Positive Surgical Margins ◽

Histopathological Grade ◽

T Stage

Backgroud/Objectives: Transoral laser laryngeal microsurgery (LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with LTLM as a single-modality therapy in a single-center study. Methods: Patients with early-stage (Tis-1–2/N0) glottic LSCC who underwent LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. Results: One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T1 stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of “wait and see” modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001). Conclusion: The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

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Aggressive Angiomyxoma: A Rare Perineal Mass

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v3i3.98 ◽

2019 ◽

Vol 3 (3) ◽

pp. 172

Author(s):

Mehmet Sait Ozsoy ◽

Nuray Colapkulu ◽

Aman Gapbarov ◽

Ozgur Ekinci ◽

Nesrin Gunduz ◽

...

Keyword(s):

Gold Standard ◽

Immunohistochemical Staining ◽

Surgical Margin ◽

Surgical Margins ◽

Time Range ◽

Aggressive Angiomyxoma ◽

Rare Tumour ◽

Positive Surgical Margins ◽

S 100 ◽

History Of

Aggressive angiomyxoma (AAM) is a rare tumour that usually occurs in females at reproductive ages and affects pelvic region. We herein report a case of perineal AAM to conribute to the literature about pathological features and clinical outcomes of this tumour. A 36 year old female with no history of chronic diseases presented to our hospital with a nontender perineal mass. The mass was present for two years and it first appeared during pregnancy. She underwent surgery for local resection. The histology of the mass was consistent with AAM and multifocal extention into surgical margins was observed. With immunohistochemical staining the tumor was positive for desmin, CD31, CD34, ER and PR; poorly focal positive for SMA and negative for S-100. Ki67 was less than 1%. Due to surgical margin positivity she had a second operation. After the resection with clear margins, patient showed no signs of reccurence for 7 months. Resections with positive surgical margins were mostly concluded as reccurent with wide time range and reccurence rates, extended surgical resection is gold standard for management of this tumour.International Journal of Human and Health Sciences Vol. 03 No. 03 July’19. Page: 172-174

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Reflector Localization of Breast Lesions and Parameters Associated with Positive Surgical Margins in Women Undergoing Breast Conservation Surgery

Journal of Breast Imaging ◽

10.1093/jbi/wbaa051 ◽

2020 ◽

Vol 2 (5) ◽

pp. 462-470

Author(s):

Cherie M Kuzmiak ◽

Suk Jung Kim ◽

Sheila S Lee ◽

Sheryl G Jordan ◽

Kristalyn K Gallagher ◽

...

Keyword(s):

Breast Conservation ◽

Surgical Margin ◽

Surgical Margins ◽

Breast Conservation Surgery ◽

Positive Surgical Margin ◽

Breast Lesions ◽

Positive Surgical Margins ◽

Final Pathology ◽

Lesion Type ◽

Malignant Diagnosis

Abstract Objective To evaluate our experience with reflector localization of breast lesions and parameters influencing surgical margins in patients with a malignant diagnosis. Methods A retrospective institution review board–approved review of our institutional database was performed for breast lesions preoperatively localized from September 1, 2016, through December 31, 2017. Wire localizations were excluded. From electronic medical records and imaging, the following data was recorded: breast density, lesion type and size, reflector placement modality and number placed, reflector distance from lesion and skin, excision of lesion and reflector, tissue volume, margin status, and final pathology. Statistical analysis was performed with a Fisher’s exact test, Mann-Whitney test, and logistic regression. P < 0.05 was significant. Results A total of 111 reflectors were deployed in the breasts of 103 women with 109 breast lesions. Ninety (81.1%) reflectors were placed under mammographic guidance and 21 (18.9%) under US. The lesions consisted of 68 (62.4%) masses, 17 (15.6%) calcifications, 2 (1.8%) architectural distortions, and 22 (20.2%) biopsy markers. Fourteen (21.2%) of 66 cases with a preoperative malignant diagnosis had a positive surgical margin. Final pathology, including 6 lesions upgraded to malignancy on excision, demonstrated 72 (66.0%) malignant, 22 (20.2%) high-risk, and 15 (13.8%) benign lesions. Univariate and multivariate analysis revealed no statistically significant parameters (lesion type or size, placement modality, reflector distance to skin or lesion, specimen radiography or pathology) were associated with a positive surgical margin. Conclusion Reflector localization is an alternative to wire localization of breast lesions. There were no lesion-specific or technical parameters affecting positive surgical margins.

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Correlation of biologic recurrence after radical prostatectomy and a positive surgical margin with the predominant Gleason pattern on the specimen.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15145 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15145-e15145

Author(s):

Yann Neuzillet ◽

Audrey Pichon ◽

Thierry Lebret ◽

Jean-Pierre Raynaud ◽

Henry Botto

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Surgical Margin ◽

Surgical Margins ◽

Rank Test ◽

Multivariate Logistic Regression Model ◽

Positive Surgical Margin ◽

Positive Surgical Margins ◽

Gleason Pattern

e15145 Background: The risk of biological recurrence following radical prostatectomy depends, among other factors, on surgical margins status. This study compared the prognosis of prostate cancer patients with positive surgical margins according to the predominant Gleason pattern (PrdGP). Methods: Prospective study of 247 consecutive prostate cancer patients, who underwent radical prostatectomy (RP) from 3/2007 to 12/2009, and were followed up in our institution. Pathological stage and Gleason score were determined in RP specimens by a pathological reference. Biological recurrence was defined as two consecutive values of PSA > 0.2 ng/mL. The median overall follow-up was 33 months (2 to 54 months). Biological recurrence-free survival was estimated and compared using Kaplan-Meier plots and Log rank test. A multivariate logistic regression model was done with PrdGP4, and two other predictive variables (pT≥3a, preoperative PSA level) entered as statistically significant independent predictors of biological recurrence. Results: Forty-eight patients (19.4%) had a positive surgical margins, 26 patients have PrdGP3 (54%) and 22 have PrdGP4 (46%). Whereas 7 biological recurrences were observed in PrdGP4 patients, none occurred in PrdGP3 patients. Biological recurrence-free survivals were significantly different (Log rank p=0.001). In multivariate analysis, PrdGP4 was a predictor of biological recurrence (p<0.0001, OR= 9.023, 95% CI [3.161–25.757]). Conclusions: This study demonstrates that biological recurrence after positive surgical margin are correlated with the predominant Gleason pattern assessed on radical prostatectomy specimen which s more easily evaluable than accurate margins features. Adjuvant treatment, specifically external beam radiotherapy, should be indicated in accordance to this result. [Table: see text]

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Population-based comparison of surgical margin status for robotic versus open radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.51 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 51-51

Author(s):

Jim C. Hu ◽

Giorgio Gandaglia ◽

Paul Linh Nguyen ◽

Quoc-Dien Trinh ◽

Ya-Chen T. Shih ◽

...

Keyword(s):

High Risk ◽

Radical Prostatectomy ◽

Odds Ratio ◽

Surgical Margin ◽

Cancer Control ◽

Margin Status ◽

Surgical Margins ◽

Positive Surgical Margins ◽

Open Radical Prostatectomy ◽

High Risk Disease

51 Background: Robotic-assisted radical prostatectomy (RARP) remains controversial due to exaggerated marketing claims, higher costs, hidden risks, and few clinically significant benefits, including an absence of improved cancer control compared to open radical prostatectomy (ORP). The purpose of our study is to compare surgical margin status by surgical approach. Methods: We identified 13,434 men with a histologically confirmed, non-metastatic prostate cancer treated with RARP versus ORP during 2004 and 2009 from Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data. Propensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of radical prostatectomy surgical margin status by surgical approach. Results: During the study period, 5,556 and 7,878 men underwent RARP and ORP, respectively. In the propensity-adjusted cohort, the incidence of positive surgical margins was significantly lower among men undergoing RARP versus ORP (13.7% vs. 18.4%, odds ratio [OR]: 0.68, 95% confidence interval [CI]: 0.63–0.73, p<0.001). This reduction in the incidence of positive surgical margins of RARP over ORP was more pronounced among men with more advanced disease—6.6% lower absolute incidence of positive margins among men with intermediate- and high-risk disease (p<0.001, respectively) and 15.4% lower absolute incidence of positive margins among men with extracapsular extension (p<0.001). Moreover, RARP was associated with lower odds of positive surgical margins compared to ORP for pT2 (Odds Ratio [OR] 0.67, 95% Confidence Interval [CI] 0.61–0.74, p<0.001) and pT3a (OR 0.72, 95% CI 0.60–0.85, p<0.001) disease. Additionally, RARP was associated with lower odds of positive surgical margins for intermediate (OR 0.66, 95% CI 0.58–0.74) and high-risk (OR 0.69, 95% CI 0.64–0.75) disease. Conclusions: RARP was associated with improved surgical margin status among men with intermediate and high-risk disease. This has important implications for cancer control, patient quality of life, health care delivery and additional costs of downstream therapies.

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Oncological outcomes of positive surgical margins in partial nephrectomy for renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16079 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16079-e16079 ◽

Cited By ~ 1

Author(s):

Henrique T. S. Nonemacher ◽

Mauricio Cordeiro ◽

George Lins de Albuquerque ◽

Fabio Galucci ◽

Paulo Afonso de Carvalho ◽

...

Keyword(s):

High Risk ◽

Partial Nephrectomy ◽

Surgical Margin ◽

Positive Margin ◽

Disease Recurrence ◽

Surgical Margins ◽

Positive Surgical Margin ◽

Positive Surgical Margins ◽

Risk Of Disease ◽

Risk Of Relapse

e16079 Background: The prognostic significance and optimal management of positive surgical margins following partial nephrectomy remain controversial. The association between positive margin and risk of disease recurrence in patients with clinically localized renal neoplasm undergoing partial nephrectomy was evaluated. Methods: We analyzed the records of 429 patients cases of non-metastatic renal cell carcinoma who underwent partial nephrectomy (PN) at our institution, from 2001 to 2016. Recurrence free-survival was evaluated using Kaplan–Meier method and the log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (Fuhrman grades III-IV) and low risk (Fuhrman grades I-II) groups Results: A positive surgical margin was found in 55 (12.8%) patients. Recurrence developed in 26 (6%) patients during a median follow up of 39 months. A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 3.19, CI 95% 1.21 – 7.61 p=0.02) (Table). In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases of high risk (HR 13.8, CI 95% 4.19–45.9, p = 0.0005). Conclusions: Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with high-risk pathological features. [Table: see text]

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