Examining the Impact of Race and Sex on the Incidence of Positive Surgical Margins in Oral Cavity Squamous Cell Carcinoma

Objective: The aim of this study was to compare the incidence of positive surgical margins (PSMs) between different races and sexes in a national cohort.

Materials and methods: In this study, we analyzed the association between race and sex disparities and the incidence of PSMs based on data from the 2004-2016 National Cancer Database (NCDB). The NCDB includes deidentified data collected from over 1500 hospitals as part of the Commission on Cancer approvals program and represents over 70% of new cancer cases in the United States. This analysis provides minimally adjusted and further adjusted multivariate analyses of the incidence of positive surgical margins in OCSCC stratified by sex and race, disease characteristics, other demographics, comorbidities, and social determinants of health (SDOH).

Results: The incidence of PSMs was found to be elevated in black males of any age, black males under the age of 45, and in Indigenous American and native Alaskan males under the age of 45, independent of clinicopathologic factors. Specifically, black patients had a significantly higher incidence of PSMs when controlling for age, subsite, stage, grade, LVI, and CDCS. Our results remained unchanged after adjusting for the SDOH variables of insurance coverage, level of education, income, metropolitan versus urban versus rural location, distance from treatment center, and facility type.

Conclusion: The findings of this study suggest that black males of any age, black males under 45, and Indigenous American and native Alaskan males under 45 have a higher incidence of PSMs, independent of clinicopathologic factors and SDOH. Our findings may help inform clinicians and hospitals of lapses in our healthcare system that perpetuate these inequities and further the goal of tackling disparities in surgical care.