Liu Fei, Chu Yinglin, Zheng Qizhe, Hu Yunshuang, Wang Yiyi, Qin Lu, Fu Shuaikun, Wang Suping
Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Oral Medicine, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China.
Front Oncol. 2025 Jan 17;14:1466196. doi: 10.3389/fonc.2024.1466196. eCollection 2024.
To delineate the distribution of perineural invasion (PNI), evaluate its impact on patient survival, and identify optimal criteria for initiating adjuvant radiation therapy (RT) in cases of PNI associated with salivary gland cancer (SGC).
This retrospective study categorized enrolled patients into three groups based on PNI status (none, minor, or major), defined by the extent of nerve involvement. The influence of PNI on overall survival and locoregional control was assessed using a Cox proportional hazards model.
A total of 555 patients were incorporated into the study. Logistic regression analysis indicated that tumor stage, neck stage, histological grade, and pathological type were independently linked to the occurrence of PNI. In the Cox model assessing overall survival, patients exhibiting minor nerve PNI demonstrated a hazard ratio (HR) of 1.78 [95% CI: 1.14-2.47] in comparison to those without PNI, a difference that was statistically significant (p<0.001). Conversely, the variation in HR between patients with major nerve PNI and those with minor nerve PNI was not statistically significant (p=0.673). In the Cox model for locoregional control, patients with minor and major nerve PNI exhibited HRs of 1.64 [95% CI: 1.17-2.78] and 1.65 [95% CI: 1.03-2.90], respectively, when compared to those without PNI. Subgroup analyses revealed that the incorporation of chemotherapy into radiotherapy did not significantly modify the risk of mortality or locoregional recurrence in comparison to patients treated with radiotherapy alone, irrespective of PNI classification.
Both minor and major nerve PNI exerting comparable influences on prognosis, the adjunctive use of chemotherapy in combination with RT did not yield improvements in overall survival or locoregional control, irrespective of PNI status.
明确神经周围侵犯（PNI）的分布情况，评估其对患者生存的影响，并确定在涎腺癌（SGC）相关PNI病例中启动辅助放疗（RT）的最佳标准。
这项回顾性研究根据神经受累程度定义的PNI状态（无、轻微或严重）将纳入的患者分为三组。使用Cox比例风险模型评估PNI对总生存和局部区域控制的影响。
共有555例患者纳入本研究。逻辑回归分析表明，肿瘤分期、颈部分期、组织学分级和病理类型与PNI的发生独立相关。在评估总生存的Cox模型中，与无PNI的患者相比，表现出轻微神经PNI的患者的风险比（HR）为1.78 [95%CI：1.14 - 2.47]，差异具有统计学意义（p<0.001）。相反，严重神经PNI患者与轻微神经PNI患者之间的HR差异无统计学意义（p = 0.673）。在局部区域控制的Cox模型中，与无PNI的患者相比，轻微和严重神经PNI患者的HR分别为1.64 [95%CI：1.17 - 2.78]和1.65 [95%CI：1.03 - 2.90]。亚组分析显示，与单纯接受放疗的患者相比，无论PNI分类如何，在放疗中加入化疗并未显著改变死亡风险或局部区域复发风险。
轻微和严重神经PNI对预后的影响相当，无论PNI状态如何，化疗联合RT在总生存或局部区域控制方面均未带来改善。
