Aivazian Karina, Ebrahimi Ardalan, Low Tsu-Hui Hubert, Gao Kan, Clifford Anthony, Shannon Kerwin, Clark Jonathan R, Gupta Ruta
Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
J Surg Oncol. 2015 Mar;111(3):352-8. doi: 10.1002/jso.23821. Epub 2014 Oct 31.
Evidence regarding the prognostic value of perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) and whether PNI alone warrants consideration of adjuvant therapy is controversial. We evaluated whether histopathological sub-categorization of PNI improves risk stratification.
PNI was evaluated for nerve size, number of foci, and distance from the tumor in 318 OSCC patients. Univariable and multivariable analyses were performed, with local failure (LF) and disease-specific survival (DSS) as the primary endpoints.
PNI did not influence prognosis when classified as absent versus present. In contrast, multifocal PNI was associated with LF (P = 0.049) and decreased DSS (P = 0.043) on multivariable analyses. The size of the involved nerve separated those with multifocal PNI into intermediate (<1 mm) and high-risk (≥1 mm) groups. Unifocal PNI and distance from the tumor did not influence prognosis. Multifocal PNI was associated with worse prognosis irrespective of post-operative radiotherapy (PORT).
Multifocal PNI is associated with poor outcomes even with PORT suggesting consideration of therapeutic escalation, particularly with involved nerves ≥1 mm. Unifocal PNI did not affect prognosis even in the absence of PORT, which may not be required if this is the sole risk factor. Prospective validation and testing of these hypotheses is essential before implementation.
关于神经周围浸润（PNI）在口腔鳞状细胞癌（OSCC）中的预后价值以及PNI单独是否需要考虑辅助治疗存在争议。我们评估了PNI的组织病理学亚分类是否能改善风险分层。
对318例OSCC患者的PNI进行神经大小、病灶数量和距肿瘤距离的评估。进行单变量和多变量分析，以局部失败（LF）和疾病特异性生存（DSS）作为主要终点。
PNI分类为无或有时不影响预后。相比之下，多灶性PNI在多变量分析中与LF相关（P = 0.049）且DSS降低（P = 0.043）。受累神经的大小将多灶性PNI患者分为中度（<1 mm）和高危（≥1 mm）组。单灶性PNI和距肿瘤距离不影响预后。无论术后放疗（PORT）如何，多灶性PNI都与较差的预后相关。
即使进行PORT，多灶性PNI也与不良预后相关，提示考虑加强治疗，特别是对于受累神经≥1 mm的情况。即使没有PORT，单灶性PNI也不影响预后，如果这是唯一的风险因素，可能不需要PORT。在实施之前，对这些假设进行前瞻性验证和测试至关重要。
