Yang Xi, Tian Xuerui, Wu Kailiu, Liu Wei, Li Siyi, Zhang Zhiyuan, Zhang Chenping
Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, China.
Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, China.
Surg Oncol. 2018 Jun;27(2):123-128. doi: 10.1016/j.suronc.2018.02.005. Epub 2018 Feb 15.
Although perineural invasion (PNI) has been recognized as a poor prognostic factor for oral cancer, few studies have focused on tongue squamous cell carcinoma (TSCC). Using a prospective randomized trial, this study investigated the role of PNI in the regional control and survival of the patients with cT1-2N0 TSCC, and clarified the benefit of neck management based on PNI status.
PNI status was reviewed under H&E staining in tumors of 221 patients with cT1-2N0 TSCC, who were randomly assigned into elective neck dissection (END) group (n = 111) and observation group (n = 110). Oncologic and survival outcomes were analyzed by multivariate regression and Kaplan-Meier analyses.
PNI was identified in 34 patients and multivariate analyses revealed that PNI remained an independent predictor for cervical lymph node metastasis (CLNM), local relapse, neck relapse and disease-specific survival (DSS) after controlling for T stage and pathologic differentiation. END could not improve the benefit for patients. Stratified analysis revealed that END also could not improve neck control or DSS among patients with PNI.
This study demonstrated that PNI was an invaluable pathological parameter to independently predict cervical metastasis, local relapse, neck relapse and poor survival outcomes, but END could not improve benefits compared to observation for the PNI-positive patients.
尽管神经周围侵犯（PNI）已被认为是口腔癌的不良预后因素，但很少有研究关注舌鳞状细胞癌（TSCC）。本研究采用前瞻性随机试验，探讨PNI在cT1-2N0期TSCC患者区域控制和生存中的作用，并阐明基于PNI状态进行颈部处理的益处。
对221例cT1-2N0期TSCC患者的肿瘤进行苏木精-伊红（H&E）染色，评估PNI状态。这些患者被随机分为选择性颈清扫术（END）组（n = 111）和观察组（n = 110）。通过多因素回归分析和Kaplan-Meier分析评估肿瘤学和生存结局。
34例患者被确定存在PNI，多因素分析显示，在控制T分期和病理分化后，PNI仍然是颈部淋巴结转移（CLNM）、局部复发、颈部复发和疾病特异性生存（DSS）的独立预测因素。END并不能改善患者的预后。分层分析显示，END也不能改善PNI患者的颈部控制或DSS。
本研究表明，PNI是独立预测颈部转移、局部复发、颈部复发和不良生存结局的重要病理参数，但对于PNI阳性患者，与观察相比，END并不能改善预后。
