Prognostic implications of perineural spread in squamous carcinomas of the head and neck

Abstract

The occurrence and prognostic implications of perineural spread were examined in 239 patients with mucosal squamous carcinomas of the head and neck. Perineural spread was demonstrated in resections from 64 patients (27%), the majority having primary tumors at one of three sites: buccal cavity, larynx, and pharynx. Perineural spread near nodal metastases was uncommon. There was no evidence that perineural involvement was more commonly associated with large tumors or less differentiated ones. No association was established between perineural spread and coexistent lymph node deposits in the surgical resections. Perineural spread was, however, shown to be a statistically significant prognostic factor for an increased incidence of subsequent locoregional recurrence and for decreased survival.

Role of perineural invasion as a prognostic factor in laryngeal cancer

“…Previous studies by Soo et al (8) reported that the survival rate of patients with laryngeal cancer were reduced from 49 to 23% following 3 years of treatment if the patients developed PNI. In the past, the pathogenic model of laryngeal cancer with PNI was considered to be associated with the lymphatic dissemination of tumor cells within the nerve (8). However, this model was later rejected, since the lymphatic channels do not penetrate the inner sanctum of the nerve sheath.…”

“…In the 7th edition of the AJCC staging system for the classification of squamous cell carcinomas, published in 2010, PNI was included among the high-risk factors for patients with laryngeal cancer (16). Previous studies by Soo et al (8) reported that the survival rate of patients with laryngeal cancer were reduced from 49 to 23% following 3 years of treatment if the patients developed PNI. In the past, the pathogenic model of laryngeal cancer with PNI was considered to be associated with the lymphatic dissemination of tumor cells within the nerve (8).…”

“…PNI is an independent negative prognostic factor associated with a lesser loco-regional control of the disease and poor survival in patients with laryngeal cancer (1,2,(6)(7)(8)(9)(10)(11)(12)(13)(14). The aim of the present study was: i) To evaluate the prognostic importance and incidence of PNI; ii) to correlate the infiltration rate with factors associated to the tumor, including histotype, site and tumor-node-metastasis stage (TNM), and with the type of surgery (total or partial laryngectomy); iii) to evaluate the disease-free survival rate according to the outcome of combined surgery and radiotherapy (RT) treatment; and iv) to formulate a specific follow-up protocol for patients with laryngeal cancer and PNI, depending on the clinical and histopathological characteristics of the tumor.…”

Parotid adenoid cystic carcinoma: Retrospective single institute analysis

“…1a, c, d), where the above mentioned variables were the main prognostic factors involved except for the DM incidence which was affected mainly by solid pathologic pattern of growth. By analyzing each single significant factor, perineurial invasion has already shown its association with a high local failure in head and neck cancers [22], and the reason lays in the correlated high probability of residual microscopic disease in adjacent tissues. In contrast with this, positive microscopic resection margins status resulted in our case series to be a strong predictor in all survival analyses for all parotid malignancies rather than the ACC, suggesting a more important prognostic role acted by other pathologic variables such PNI and solid pattern of growth.…”

Perineural Spread of Distant Squamous Cell Carcinoma to the Orbit: A Case Report and Review

“…These features were identified in our histopathological sections. In 239 patients with mucosal squamous carcinomas of the head and neck, PNS was demonstrated in resections of 64 patients (27%), the majority having primary tumors at one of three sites: buccal cavity, larynx, and pharynx [5].…”