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. 2013 Dec;149(6):893-9.
doi: 10.1177/0194599813506867. Epub 2013 Oct 23.

Impact of perineural invasion in the pathologically N0 neck in oral cavity squamous cell carcinoma

Steven B Chinn  1 , Matthew E Spector, Emily L Bellile, Jonathan B McHugh, Thomas J Gernon, Carol R Bradford, Gregory T Wolf, Avraham Eisbruch, Douglas B Chepeha
Affiliations

Impact of perineural invasion in the pathologically N0 neck in oral cavity squamous cell carcinoma

Steven B Chinn et al. Otolaryngol Head Neck Surg. 2013 Dec.

Abstract

Objective: Patients with oral cavity squamous cell carcinoma (OCSCC) undergo adjuvant radiation for pathologically high-risk features including positive nodal disease and extracapsular spread (ECS). In the absence of these high-risk features, our objective was to determine if perineural invasion (PNI) is an independent risk factor and if adjuvant radiation (XRT) improves disease control rates.

Study design: Historical cohort analysis.

Setting: Tertiary university hospital.

Methods: Eighty-eight OCSCC patients (46 males, 42 females; mean age = 56.7 years; median follow-up = 4.6 years) treated surgically with pathologically N0 (pN0) necks were studied. Overall, 23% (20/88) were pN0/PNI+ and of those with PNI, 70% (14/20) underwent XRT. Survival analysis using Kaplan-Meier followed by multivariable Cox models was performed.

Results: Multivariate analysis verified PNI to be associated with worse disease-free interval (DFI) (P = .012) and local-regional control (LRC) (P = .005) and perivascular invasion (PVI) associated with worse DFI (P = .05). Among pN0/PNI+ patients, those who received XRT demonstrated significantly improved DFI (mean = 6.5 years vs 1.7 years; P = .014) and LRC (mean 6.7 years vs 1.9 years; P = .047). There was no improvement in overall survival (P = .68) or disease-specific survival (P = .8) in those receiving XRT.

Conclusions: PNI is an independent adverse risk factor in the absence of nodal metastasis and extracapsular spread. We observed a statistically significantly longer DFI and LRC when patients were treated with adjuvant radiation.

Keywords: oral cavity; perineural invasion; squamous cell carcinoma.

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Figures

Figure 1
Figure 1
KM pN0/PNI+ v pN0/PNI− (A) Local-regional control, (B) Disease specific survival, (C) Overall Survival.
Figure 2
Figure 2
KM pN0/PNI+/XRT+ v. pN0/PNI+/XRT- (A) Local-regional control, (B) Disease specific survival, (C) Overall Survival.
See this image and copyright information in PMC

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