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Subcategorization of Perineural Invasion and Its Impact on Survival in Patients with Oral Squamous Cell Carcinoma

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Abstract

Background

Perineural invasion (PNI) is  recognized as a poor prognostic factor in oral squamous cell carcinoma (OSCC). However, the prognostic significance of further histologic  subcategorization of PNI is inconclusive. In this study, we determined the prognostic relevance of histologic subcategories of PNI and their correlation with the presence of other clinical and pathological parameters

Methods

This is a retrospective study of 207 homogeneously treated OSCC patients with histologically documented PNI from a single center. Univariate and multivariate survival outcomes, namely, local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) of patients with various subcategories of PNI,namely- number of foci, size of the involved nerve, extratumoral or intratumoral extent, and intraneural or perineural location—were determined.

Results

Within the histologic subcategories of PNI, tongue primary and presence of lymph node metastasis correlated significantly with the number of nerves involved with PNI. Larger size of involved nerve correlated with advanced tumor stage. Number of foci, extent, and location of PNI were not prognostically significant except size of the involved nerve which showed an inverse correlation with disease outcome as involvement of larger nerves displayed better outcomes in terms of DFS and LRFS but not of OS on multivariate analysis. Addition of adjuvant chemotherapy to radiotherapy emerged as a significant predictor of improved LRFS, DFS, and OS.

Conclusions

Histologic subcategorization of PNI did not have prognostic relevance in our study. Involvement of even small nerves was associated with poor prognosis. Addition of chemoradiation was seen to improve prognosis.

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Data Availability

The data and material of this study are available from the corresponding author upon reasonable request.

Code Availability

Not applicable.

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Acknowledgements

The authors would like to thank Mr. Surajit Bag and Mr. Debabrata Das for technical assistance.

Funding

This study was not supported by any funding. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Pathology, Tata Medical Center, Newtown, Kolkata, 700160, India

    Indu Arun, Paromita Roy & Shahin Hameed

  2. Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, 700160, India

    Prateek Vijay Jain, Kapila Manikantan & Pattatheyil Arun

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Contributions

IA: study design, data collection, histopathological analysis, and manuscript writing. PR: data collection, histopathological analysis, and manuscript review. PJ: data collection and manuscript review. SH: data collection and manuscript review. KM: data collection and manuscript review. PA: concept, study design, statistical analysis, and manuscript writing.

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Correspondence to Pattatheyil Arun.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethical approval was obtained from the Institutional Review Board (IRB) at our institute for this study (No.EC/WV/TMC/48/20).

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Not applicable. This study has obtained Institutional Review Board (IRB) at our institute and the need for informed consent was waived.

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Supplementary Information

Supplementary Figure. Survival analysis: PNI subcategories. Kaplan–Meier Curves comparing LRFS (Panel A), DFS (Panel B), and OS (Panel C) between various PNI subcategories. p values within the graphs indicate the log-rank statistic. None of the PNI subcategories demonstrated a significant difference in either LRFS, DFS, or OS on univariate analysis. Abbreviations: LRFS-Locoregional recurrence-free Survival; DFS-Disease-free survival; OS-Overall survival.

Supplementary file1 (TIF 4275 kb)

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Arun, I., Roy, P., Jain, P.V. et al. Subcategorization of Perineural Invasion and Its Impact on Survival in Patients with Oral Squamous Cell Carcinoma. Head and Neck Pathol 17, 383–392 (2023). https://doi.org/10.1007/s12105-022-01512-y

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