Prognostic significance of vascular and perineura invasion in cancer of the larynx

Yılmaz, Taner; Hoşal, Ali Şefik; Gedikoğlu, Gökhan; Önerci, Metin; Gr̈sel, Bülent

doi:10.1016/s0196-0709(98)90100-4

Cited by 69 publications

(76 citation statements)

References 6 publications

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“…Previous studies have confirmed that patients with PNI whose nodes are clinically and instrumentally negative, exhibit an increased rate of spread to the regional nodes (1,2,16,(21)(22)(23)(24). In consequence, these patients should be subjected to elective neck dissection.…”

Section: Discussionmentioning

confidence: 92%

“…Considering the impact on prognosis, the presence of PNI affects the therapeutic options and the decision making process in patients with laryngeal cancer. In this regard, adjuvant radio-chemotherapy has been demonstrated to result in a better outcome in those patients presenting with PNI, in terms of recurrence, local control of the disease, overall survival and disease-free survival rates (2,14,16,21).…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Role of perineural invasion as a prognostic factor in laryngeal cancer

et al. 2016

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Abstract. The diffusion of laryngeal cancer cells in the perineural space is a parameter associated with a negative prognosis, high loco-regional recurrence and low disease-free survival rates. The spread of tumor cells on the perineural sheath highlights the histopathological and clinically aggressive behavior of this type of tumor, which may extend proximally or distally in the nerve for >10 cm. Therefore, the surgical resection margin is generally insufficient to treat patients with laryngeal cancer presenting with perineural invasion (PNI) with surgery alone. In PNI, the minor laryngeal nerves are frequently involved, rather than the superior and inferior laryngeal nerves. The aim of the present study was: i) To evaluate the prognostic importance of PNI; ii) to correlate the rate of infiltration with factors associated with the tumor, including histotype, site and tumor-node-metastasis stage, and with the type of surgery (total or partial laryngectomy); and iii) to evaluate the rate of disease-free survival according to the outcome of combined surgery and radiotherapy (RT) treatment, by means of retrospective analysis. The results of the present study highlighted the importance of performing a closer clinical and instrumental follow-up in patients with laryngeal cancer whose histopathological examination is positive for PNI. In such cases, it is important to complement the surgical therapeutic treatment with adjuvant RT. IntroductionPerineural invasion (PNI), also known as neurotropic carcinomatous spread, is a process predominantly characterized by neoplastic invasion of the nerves. PNI may also occur in the absence of lymphatic or vascular invasion (1-5).In PNI, the propagation of neoplastic cells to the primitive site of the tumor does not occur via lymphatic dissemination, but through molecular mediators that guide these cells during the invasion of the nerve sheath (6). The definition of PNI was first proposed in a study by Batsakis (3), according to which, PNI was 'a tumor cell invasion in, around and through the nerve'. Following multiple modifications, PNI is currently defined as 'the presence of tumor cells in the 3 layers of the nerve sheath' or 'in close proximity to nerve, involving at least 33% of its entire circumference'; below this cut-off, focal abutment rather than PNI should be considered (1,6).The incidence of PNI has been reported to vary from 6 to 50% for head and neck cancer, and <80% for squamocellular carcinoma. 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 com...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of perineural invasion as a prognostic factor in laryngeal cancer

et al. 2016

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“…Yılmaz ve ark. [15] perinöral invazyonun boyun metastazı üzerine etkisinin sınırlı olduğunu bildirmişlerdir. Çalışmamızda perinöral invazyonu olan hastalarda 2 yıllık genel sağkalım, perinöral invazyonu olmayan hastalarla eşit oranda bulunmuştur.…”

Section: Discussionunclassified

“…[15] perivasküler invazyonun lokal ve bölgesel nüksü artırdığını, uzak metastaz riskini etkilemediğini, cerrahi ile nüks arasındaki süreyi belirgin derecede kısalttığını bildirmişlerdir. Ayrıca, perivasküler ve perinöral yayılımın boyun metastazında artışa neden olarak sağkalım ve nüksü etkilediği belirtilmiştir.…”

Section: Discussionunclassified

Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler

Akkaş¹,

Yücel²,

Kılıçkap³

et al. 2013

CMJ

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Amaç. Merkezimizde takip ve tedavi edilen baş boyun kanseri hastalarında klinikopatolojik özelliklerin, tedavi sonuçlarının ve sağkalımı etkileyen prognostik faktörlerin incelenmesi amaçlanmıştır. Yöntem. 2007-2010 tarihleri arasında merkezimize başvuran ve baş boyun kanseri tanısı ile izlenmekte olan hastalara ait demografik, klinik ve histopatolojik veriler hasta dosya ve hastane kayıtları incelenerek elde edildi. Bulgular. Seksen iki hastaya ait veriler analiz edildi. 72 erkek (%88) ve 10 kadın (%12) hasta mevcuttu. Hastaların ortanca yaşı 57 (20-80) idi. En genç hastalar nazofarenks, parahipofarenks ve paranazal sinüs tümörü olan hastalardı. En yaygın malignensi 37 hastada (%45) bulunan larenks kanseri idi. Elli beş hasta (%67) Eastern Cooperative Oncology Group 1 idi. En sık evre 51 hasta (%62) ile lokal ileri evre idi. Tanı anında 60 (%75) hastada anemi, 30 (%60) hastada C-reaktif protein yüksekliği, 72 (%89) hastada kilo kaybı tespit edildi. Yassı hücreli karsinom 69 (%84) hasta ile en sık izlenen histopatolojik tip idi. On yedi (%47) hastada perinöral invazyon, 17 (%47) hastada lenfovasküler invazyon, 12 (%32) hastada ekstrakapsüler invazyon tespit edildi. Hastalar arasında en sık izlenen grade 34 (%42) hasta ile grade II idi. Tüm hastalar için ortanca sağkalım 34 aydı. İki yıllık genel sağkalım oranı erken evre (I-II) hastalarda %75, lokal ileri hastalarda (III-IVA ve B) %51 iken, metastatik hastalık varlığında ise ortanca sağkalım 10 ay idi. Eşlik eden hipertansiyon varlığı, performans durumu, kanserin lokalizasyonu ve evresi, T ve N evresi, radyoterapiye ara verilmesi, C-reaktif protein düzeyi ve anemi sağkalımı belirleyen faktörler idi. Sonuç. Hipertansiyon varlığı, performans durumu, kanserin lokalizasyon ve evresi, T ve N evresi, radyoterapiye ara verilmesi, C-reaktif protein düzeyi ve anemi baş boyun kanserli hastalarda sağkalımı etkileyen prognostik faktörler olarak belirlendi.Anahtar sözcükler: Baş boyun kanseri, radyoterapi, kemoterapi, prognoz Abstract Aim. Our aim was to investigate the clinicopathological features, the treatment outcome and the prognostic factors affecting survival in patients with head and neck cancer followed and treated in our center. Methods. The demographic, clinical and the histopathological data of the patients who were admitted to our center between 2007 and 2010 with a diagnosis of head and neck cancer were examined using the medical records. Results. The data from 82 patients were analyzed. There were 72 men (88%) and 10 women (12%). The median age of the patients was 57 (20-80) years. The youngest patients had nasopharyngeal, parahypopharyngeal and paranasal sinus tumors. The most commonly encountered malignancy was the laryngeal cancer, which was found in 37 patients (45%). Fifty-five patients (67%) were Eastern Cooperative Oncology Group 1. The most common grade was the locally advanced stage with 51 patients (62%). At time of the diagnosis, 60 (75%) patients had anemia, 30 (60%) patients had an elevated C-reactive protein, and 72 (89%) patients had weight loss....

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Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus–Positive Oropharyngeal Carcinoma

Albergotti

Schwarzbach

Abberbock

et al. 2017

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Recently, the American Joint Committee on Cancer (AJCC) updated its staging system for human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC). The prognostic significance of perineural invasion (PNI) and angiolymphatic invasion (ALI) within this staging system is unknown. OBJECTIVE To examine the prevalence and prognostic significance of PNI and ALI in HPV-positive OPSCC. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was performed of all patients with HPV-positive OPSCC treated surgically at the University of Pittsburgh Medical Center from January 1, 1980, through December 31, 2015, with at least 1 year of follow-up or death within 1 year. INTERVENTIONS Surgical treatment of HPV-positive OPSCC. MAIN OUTCOMES AND MEASURES The prevalence of PNI and ALI was determined from review of pathologic data, and Kaplan-Meier curves were generated for overall survival and disease-free survival when stratified by the presence of PNI and ALI. Multivariate analysis was performed using a Cox proportional hazards regression model. RESULTS A total of 201 patients met the inclusion criteria (mean [SD] age, 57.4 [9.0] years; 79.6% [3.0%] male, and 20.4% [3.0%] female). Perineural invasion was identified in 32 of 201 primary specimens (15.9%), whereas ALI was identified in 74 of 201 primary specimens (36.8%). Both were significantly associated with increasing T stage. On multivariate analysis, the presence of at least 1 risk factor was significantly associated with overall and disease-free survival (overall hazard ratio, 2.78; 95% CI, 1.15–6.76; disease-free survival hazard ratio, 3.10; 95% CI, 1.17–8.23). Among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of at least 1 risk factor was associated with worse overall survival (hazard ratio, 11.7; 95% CI, 1.2–111.7). CONCLUSIONS AND RELEVANCE Both PNI and ALI were commonly found in HPV-positive OPSCC, with increasing prevalence as T stage increased. The presence of at least 1 risk factor was associated with worse overall and disease-free survival. Specifically, among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of ALI or PNI may suggest a poorer prognosis.

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Prognostic significance of vascular and perineura invasion in cancer of the larynx

Cited by 69 publications

References 6 publications

Role of perineural invasion as a prognostic factor in laryngeal cancer

Role of perineural invasion as a prognostic factor in laryngeal cancer

Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler

Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus–Positive Oropharyngeal Carcinoma

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