Hakim Samer George, Alsharif Ubai, Falougy Mohamed, Tharun Lars, Rades Dirk, Kümpers Christiane, Jensen Justus
Department of Oral and Maxillofacial Surgery, Head and Neck Cancer Center, University Hospital Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany.
Department of Oral and Maxillofacial Surgery, Helios Medical Center, 19055 Schwerin, Germany.
Cancers (Basel). 2025 Aug 28;17(17):2812. doi: 10.3390/cancers17172812.
Perineural (PnI), lymphatic (LI), and vascular invasion (VI) in tumor specimens are supposed to worsen the clinical course of oral squamous cell carcinoma (OSCC) and negatively influence survival outcomes. Despite this, these histologic features have not been implemented in the international staging recommendation for OSCC and their prognostic role remains questionable due to inconsistent findings in the related literature. To investigate the impact of PnI, LI, and VI on oral cancer-specific (OCSS), recurrence-free (RFS), and overall survival (OS), we hypothesized that these histologic features are independent risk factors for poor survival and therefore considered within a prospectively maintained single-center cohort of patients with OSCC. LI and VI were assessed together and reported as lymphovascular invasion (LVI). This study included 439 patients with primary OSCC. Sixty-nine Patients (21.9%) had at least one of the two risk factors. Within the 5-year follow-up period, 61 of these patients (64%) died, and 30 patients (31%) developed locoregional recurrences. Both perineural and lymphovascular invasion were strongly correlated with the presence of lymph node metastasis. PnI and LVI were investigated separately using an adjusted Cox's proportional hazards regression model. In addition to higher tumor size and the presence of nodal disease (higher stage) the presence of LVI was associated with poor OS, OCSS, and RFS on multivariate analysis, while PnI was associated with reduced OS. In stage III/IV postoperative radiotherapy improved survival in patients with PnI but not with LVI. We conclude that the evidence of LVI in tumor specimens should be considered a high-risk factor when planning adjuvant treatment and monitoring patients with OSCC.
肿瘤标本中的神经周围浸润（PnI）、淋巴管浸润（LI）和血管浸润（VI）被认为会使口腔鳞状细胞癌（OSCC）的临床病程恶化，并对生存结果产生负面影响。尽管如此，这些组织学特征尚未纳入OSCC的国际分期推荐中，并且由于相关文献中的结果不一致，它们的预后作用仍存在疑问。为了研究PnI、LI和VI对口腔癌特异性生存（OCSS）、无复发生存（RFS）和总生存（OS）的影响，我们假设这些组织学特征是生存不良的独立危险因素，因此在一个前瞻性维持的单中心OSCC患者队列中进行了考虑。LI和VI一起评估并报告为淋巴血管浸润（LVI）。本研究纳入了439例原发性OSCC患者。69例患者（21.9%）至少有这两种危险因素中的一种。在5年随访期内，这些患者中有61例（64%）死亡，30例患者（31%）发生局部区域复发。神经周围浸润和淋巴血管浸润均与淋巴结转移的存在密切相关。使用调整后的Cox比例风险回归模型分别研究PnI和LVI。除了肿瘤体积较大和存在淋巴结疾病（分期较高）外，多因素分析显示LVI的存在与OS、OCSS和RFS较差相关，而PnI与OS降低相关。在III/IV期，术后放疗可改善PnI患者的生存，但对LVI患者无效。我们得出结论，在计划辅助治疗和监测OSCC患者时，应将肿瘤标本中LVI的证据视为一个高危因素。
