Borgstijn, A.C. (2021) De invloed van de resectiemarges op het optreden van recidieven bij solitaire, primaire plaveiselcelcarcinomen in de mondholte. thesis, Dentistry.
Full text available on request.Abstract
Surgical removal of malignant tumours in the head and neck region is a radical treatment method. Besides the tumour itself, a margin of healthy tissue needs to be removed, to make sure all tumorous tissue is removed and to minimalize the risk of locoregional recurrence. This study tried to answer the following question: What’s the optimal surgical margin in removing oral squamous cell carcinoma to prevent locoregional recurrence? The aim of this study is to determine if it’s possible to make less invasive treatment plans. The participants of this retrospective cohort study (n=174) are selected from the patients treated for a single, primary tumour in the oral cavity. Of the included patients, multiple demographics, clinical- pathological- and treatment related data was collected from their electronic patient files. Using a chi-square test, the margin at which there was no difference in proportions of locoregional recurrence was determined. A receiver operating characteristic (ROC) curve was made to determine at which margin the combination of sensitivity and specificity was the highest. A simple and multiple logistical regression analysis was performed to determine which independent variables contributed significantly to a model predicting the outcome variable, the occurrence of a locoregional recurrence. Finally, the recurrence-free- and disease-dependent survival was compared between multiple margins with a Kaplan-Meier survival analysis. The chi-square test indicated that there was no significant difference in proportion of locoregional recurrence of at a margin of 4 mm (p=0,108). At 2,9 mm, the maximum combination of sensitivity (53,3%) and specificity (71,5%) is achieved, according to the ROC-curve. The presence of a surgical margin of ≤3 mm (p=0,013) and the presence of lymph-angioinvasive growth (p=0,047) were the variables that significantly contributed to the predictive model. When the margin of 4 mm, found with the chi-square test, was used to split the subjects into groups, there was no significant difference in recurrence-free survival (p=0,094). There was still a significant difference in disease related survival at this margin (p=0,022). The optimal surgical margin of 4 mm found in this study is smaller than found in earlier research. The surgical margin is found to be an independent predictor for locoregional recurrence. Further longitudinal research is needed to determine the interaction between several pathological variables and their relation to the locoregional recurrences. New technology, like molecular biology, fluorescence and genetic research, can be used to illustrate the complex relation between the surgical margin and the occurrence of recurrences. Only when this research is conducted, changes can be made to the planning and protocols of treating oral squamous cell carcinomas.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Boeve, Dr. J. and Schepman, dr. K.P. |
| Faculty: | Medical Sciences |
| Date Deposited: | 22 May 2023 11:26 |
| Last Modified: | 22 May 2023 11:26 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3528 |
Actions (login required)
 |
View Item |