Prognostic factors
Our series identified positive excision margins as predictive factor for
tumour recurrence after TR (p=0.0401). This reiterates the importance of
complete tumour excision with sufficiently clear margins. In cases of
involved margins, considerations should be made for further surgical
resection and the use of adjuvant treatment. To our knowledge, only one
similar study found statistically significant factors predictive for
recurrence i.e., better local control and DSS in case of clear margins,
and better regional control in cases of bilateral neck prophylactic
treatment (13). On multivariate analysis, they also observed that R1 or
R2 margins were associated with a poorer DFS, despite this not reaching
statistical significance (13).
In our series, there was no correlation between the risk of tumour
recurrence and the Wang classification (p>0.9999), clinical
T stage (p>0.9999) and pathological T stage of 8th edition
of AJCC for tumours of the nasal cavity (p=0.2898). Several other series
of vestibule SCCs emphasised the absence of association between rates of
recurrence and the Wang or AJCC classification (8,9). However, the
population-based study by Agger et al. including 174 vestibule
SCCs found a significant association between DSS and the Wang
classification (2). Controversy remains regarding the accuracy of the
current staging classifications available for vestibule SCCs (8), whilst
further series may help to develop more appropriate and specific staging
systems.