Varsha B K, Radhika M B, Makarla Soumya, Kuriakose Moni Abraham, Kiran Gvv Satya, Padmalatha G V
Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India.
Department of Surgical Oncology, Head and Neck Oncology Service, Mazumdar-Shaw Cancer Center, Narayana Hrudayalaya Health City Bangalore, India.
J Oral Maxillofac Pathol. 2015 Sep-Dec;19(3):335-41. doi: 10.4103/0973-029X.174630.
Oral cancer constitutes 3% of all neoplasms and is the eighth most frequent cancer in the world. Oral squamous cell carcinoma (OSCC) corresponds to 95% of all oral cancers. It is associated with severe morbidity, recurrence and reduced survival rates. Its prognosis is affected by several clinicopathologic factors, one of which is perineural invasion (PNI). It is the third most common form of tumor spread exhibited by neurotropic malignancies that correlate with aggressive behavior, disease recurrence and increased morbidity and mortality. In this retrospective study, our aim was to assess the presence of PNI in different grades of both primary and recurrent cases of OSCC correlating it with tumor size and lymph node status. The various patterns of PNI we encountered were also noted.
PNI was assessed in 117 cases of primary and recurrent cases of OSCC. PNI was correlated with tumor thickness, lymph node status and with the different histologic grades. Location of PNI, density of PNI and various patterns of PNI were also assessed.
Chi-square test.
Our study showed that 47 out of 117 patients (40.5%) showed PNI. Both primary and recurrent tumors showed PNI of 42.50% and 40.50%, respectively. PNI was present in 34 out of 69 cases (49.3%) of clinically positive nodes. Around 79% of the nerves involved by PNI were intratumoral in location, 80% of the cases showed PNI density of 1-3 nerves per section and incomplete and/or "crescent-like" encirclement was the most common pattern of PNI noted in our study.
Our study showed that the incidence of PNI was as high as 40% in OSCC. PNI was present in both primary and recurrent tumors, irrespective of its histologic grading. Tumor thickness and lymph node status correlated well with PNI. Therefore, the presence of PNI should be checked in every surgical specimen with OSCC as it gives significant prognostic value, influences treatment decisions, recurrence and distant metastasis. The presence of PNI necessitates more aggressive resection, coincident management of neck lymph nodes and the addition of adjuvant therapy. Also, targeted drug therapy for this type of tumor spread can open up new avenues in the treatment of OSCC.
口腔癌占所有肿瘤的3%，是全球第八大常见癌症。口腔鳞状细胞癌（OSCC）占所有口腔癌的95%。它与严重的发病率、复发率及生存率降低相关。其预后受多种临床病理因素影响，其中之一是神经周围侵犯（PNI）。它是嗜神经恶性肿瘤呈现的第三种最常见的肿瘤扩散形式，与侵袭性行为、疾病复发以及发病率和死亡率增加相关。在这项回顾性研究中，我们的目的是评估不同分级的原发性和复发性OSCC病例中PNI的存在情况，并将其与肿瘤大小和淋巴结状态相关联。我们还记录了所遇到的PNI的各种模式。
对117例原发性和复发性OSCC病例进行PNI评估。PNI与肿瘤厚度、淋巴结状态以及不同组织学分级相关联。还评估了PNI的位置、密度和各种模式。
卡方检验。
我们的研究表明，117例患者中有47例（40.5%）出现PNI。原发性和复发性肿瘤的PNI发生率分别为42.50%和40.50%。69例临床阳性淋巴结病例中有34例（49.3%）存在PNI。约79%受PNI侵犯的神经位于肿瘤内，80%的病例PNI密度为每切片1 - 3条神经，不完全和/或“新月形”包绕是我们研究中最常见的PNI模式。
我们的研究表明，OSCC中PNI的发生率高达40%。原发性和复发性肿瘤均存在PNI，无论其组织学分级如何。肿瘤厚度和淋巴结状态与PNI密切相关。因此，对于每例OSCC手术标本都应检查是否存在PNI，因为它具有重要的预后价值，影响治疗决策、复发和远处转移。PNI的存在需要更积极的切除、同期处理颈部淋巴结并加用辅助治疗。此外，针对这种类型肿瘤扩散的靶向药物治疗可为OSCC的治疗开辟新途径。
