Perineural Invasion in Squamous Cell Carcinoma of the Head and Neck

Abstract

Perineural invasion of small nerves is associated with an increased risk of local recurrence and cervical metastasis and is, independent of extracapsular spread, a predictor of survival for patients with SCC of the upper aerodigestive tract.

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck

“…Shaha et al reported metastasis in nodes of the posterior triangle of the neck in 5% of patients with cancer of the oral cavity [134]. When the cancer is in the midline, bilateral neck metastasis can occur [6,45].…”

“…Histopathologic factors like tumor thickness, perineural and microvascular invasions, lymphocytic inflammatory infiltration, pattern of tumor invasion and differentiation, and molecular tumor markers have been advocated to be reliable metastastic potential parameters [45,58,97,150,166]. A report on a multivariable clinicopathologic scoring system in which points were allotted to each individual variable or predictor has been document [135].…”

“…Neck node status is the single most important prognostic factor in oral cancers and other head and neck cancers [26]. The incidence of lymph node metastases of these cancers depends largely on histo-pathologic factors like tumor thickness, perineural and microvascular invasions, lymphocytic inflammatory infiltration, pattern of tumor invasion and differentiation, and molecular tumor markers [45,58,140,150].…”

“…The benefits of neck dissection as advocated by this group include successful reduction of regional recurrence, pathological staging of neck, avoidance of unnecessary neck irradiation and indication of cases where adjunct therapy should be employed [45,58,71,97,99,140,150,169].…”

Prognostic Indicators in Head and Neck Oncology Including the New 7th Edition of the AJCC Staging System

“…Interestingly, perineural invasion, a component of our Risk Model (see below) was never part of these models. Most data supporting associations of perineural invasion with outcome are derived from univariate analyses [21]. Few studies demonstrate that perineural invasion maintains prognostic significance after multivariable modeling [22][23][24].…”