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Arch Otolaryngol Head Neck Surg. 1998 Jun;124(6):637-40.

Perineural invasion in squamous cell carcinoma of the head and neck.

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  • 1Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA.

Abstract

OBJECTIVE:

To determine if perineural invasion (PNI) of small nerves affects the outcome of patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract.

DESIGN:

Retrospective clinicopathological study of patients with at least 2 years of follow-up and with negative margins and no prior, synchronous, or metachronous SCC.

SETTING:

Academic otolaryngology department.

PATIENTS:

One hundred forty-two patients who had SCC of the oral cavity, oropharynx and hypopharynx, or larynx resected between 1981 and 1991.

INTERVENTION:

Surgery with or without adjuvant therapy.

MAIN OUTCOME MEASURES:

Local recurrence was examined with respect to PNI, nerve diameter, and microvascular or microlymphatic invasion. Perineural invasion was correlated with lymph node metastasis, extracapsular spread, and survival.

RESULTS:

Perineural invasion of nerves less than 1 mm in diameter was present in 74 patients, lymphatic invasion in 53, and vascular invasion in 9. Perineural invasion was significantly associated with local recurrence (23% for PNI vs 9% for no PNI; P=. 02), and disease-specific mortality (54% mortality for PNI vs 25% for no PNI; P<.001). With extralaryngeal tumors, PNI was associated with nodal metastasis (73% vs 46%; P=.03). Perineural invasion was not associated with extracapsular spread (P=.47). Microvascular invasion, lymphatic invasion, and nerve diameter were not significantly related to local recurrence.

CONCLUSIONS:

Perineural invasion of small nerves is associated with an increased risk of local recurrence and cervical metastasis and is, independent of extracapsular spread, a predictor of survival for patients with SCC of the upper aerodigestive tract.

PMID:
9639472
[PubMed - indexed for MEDLINE]
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