Positive Surgical Margins More Likely Among Black Men With Oral Cancer

MONTREAL –The rate of positive surgical margins was higher in Black men with oral cavity squamous cell carcinoma (OCSCC) than others, a retrospective cohort study suggested.

Records from the National Cancer Database for 2004-2016 showed that the overall risk of a positive margin after surgery for OCSCC was 26% greater for Black men (odds ratio [OR] 1.26, 95% CI 1.05-1.51, P=0.012), when adjusted for age, cancer stage, cancer grade, level of education, insurance coverage, and multiple other variables including social determinants of health, reported Jacob Brady, MD, of the University of Washington in Seattle.

At the annual meeting of the American Head & Neck Society, Brady also said that when the results were stratified by age, Black men under age 45 were more than twice as likely to have positive margins than others (OR 2.23, 95% CI 1.17-4.25, P=0.015), though after further adjustment for factors such as distance from treatment center and the type of facility where the surgery was performed, the analysis missed statistical significance (OR 2.59, 95% CI 0.96-6.47, P=0.060).

“Margin status following definitive curative intent or resection of oral cavity squamous cell carcinoma plays an integral role in determining post-operative treatment,” Brady said in his presentation. “And unfortunately, when we have positive post-operative margins, we find that long-term survival, both disease-specific and overall, is decreased,” he added.

“Studies have shown that Black Americans unfortunately are 50% more likely to die of head and neck cancer rather than other race groups,” he said.

The researchers found there was also a high risk of positive margins among Indigenous Americans and Native Alaskans (OR 5.54, 95% CI 1.17-26.34, P=0.031). However, Brady suggested that finding may a bit unclear due to small numbers of patients compared with other groups.

Data from the National Cancer Database were used to analyze various races by sex and age, using both univariate multivariate logistic regression models. Brady said that when the researchers performed their initial analysis by race alone, “we see that Black patients have about a 70% greater risk of positive surgical margins. This is among all ages, and again, only adjusted for age. We wanted to be more granular.”

“So finally, we took this Black male cohort and we said, ‘Can we try to at least partially maybe explain why we’re seeing this imbalance in positive margins after surgery?’ So, we also adjusted for those additional social determinants of health and we see, again in this model, that Black male patients [have] about a 26% increased risk for positive surgical margins after upfront definitive surgery for oral cavity squamous cell carcinoma.”

“Further work should focus on identifying factors that contribute to inequality in head and neck surgical outcomes,” he said. “Head and neck surgeons should be aware of this inequality when treating this patient population.”

Questions from the audience focused on reasons for the inequality, including suggestions that physician skill and type of facility may have a role. In comments to MedPage Today, co-moderator of the oral session John Gleysteen, MD, of the University of Tennessee Health Science Center in Memphis, speculated that these might be possible explanations for the difference in margin positivity.

“If you have an area where it’s underserved and maybe the surgeon there is not a cancer specialist and is a general surgeon, and if this surgeon is just at the facility once or twice a month, it could lead to some variation in outcomes,” Gleysteen said. “But we are just guessing. The researchers didn’t have any data on this.”

“They did their best to control for as many of those factors as possible,” he added. “I tend to think the finding is real — not just because they have a lot of numbers that make it easier to get a significant figure. It is challenging to determine where the problem lies.”

Ed Susman is a freelance medical writer based in Fort Pierce, Florida, USA.

Disclosures

Brady disclosed no relationships with industry.

Gleysteen disclosed relationships with Zimmer Biomet and True Digital Systems.

Primary Source

American Head & Neck Society

Source Reference: Brady J, et al “Examining the impact of race and gender on the rate of positive surgical margins in young patients with oral cavity squamous cell carcinoma” AHNS 2023.

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