Rethinking Surgical Margins: A New Approach to Predict Outcomes in Oral Squamous Cell Carcinoma

Objective: The traditional categorical division of surgical margins using a 5 mm cutoff in oral cavity squamous cell carcinoma (OCSCC) is controversial. The primary aim of this study was to investigate the presence of an optimal cutoff point or, alternatively, assess the potential improvement in predictive value by considering the surgical margins as a continuum. Methods: Retrospective analysis of OCSCC patients at a tertiary medical center in 1995–2020. Clinical, pathological, and surgical data were evaluated for effect on survivability by regression analyses. Results: The cohort included 266 patients (48.1% male, mean age 65.4 ± 17.7). Patient stratification by categorical margin status yielded no significant between-group differences in survival (p = 0.54). Significance was achieved when margin distance was reevaluated as a continuous variable (p = 0.0018). Similar results were shown in local control (categorical p = 0.59 vs. continuous p = 0.06). Multivariate model excluded possible confounders. A predictive model was created to provide a more accurate prediction of survival. Conclusions: The continuum spectrum of margin distance better predicts survival outcomes and locoregional control in OCSCC. Level of Evidence: 3 Laryngoscope, 135:161–167, 2025.