Increased Presence of Perineural Invasion At the Tongue and Floor of Mouth; Could It Represent A More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

Publication date: Available online 27 July 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Roderick Y. Kim, Joseph I. Helman, Thomas M. Braun, Brent B. Ward

Abstract

Purpose

Despite data showing worse outcomes and aggressive disease behavior, perineural invasion (PNI) has not been well characterized in terms of tumor location, histopathologic features, or cervical lymph node status. The specific aims of this study were to measure correlations between perineural invasion, location of tumor, and other known histopathologic characteristics used to define aggressive disease.

Material and Methods

This was a retrospective cohort study of adult subjects with primary squamous cell carcinoma of the oral cavity who underwent neck dissection. We excluded subjects whose neck was previously treated with surgery or radiation. Demographic and histopathological variables of interest were obtained from the patient chart. The primary outcome of interest was perineural invasion, and predictors of interest included location of tumor, histopathologic tumor characteristics and cervical lymph node status. For continuous variables, mean differences were compared with a t-test. For categorical variables, the differences in the distribution of the proportions were analyzed with a chi-squared test. All variables were entered simultaneously into a multivariate logistic regression model to control for possible confounding. Statistical significance for the study was set at a p-value less than 0.05.

Results

Three hundred and seventy-three subjects met the study criteria. Perineural invasion showed statistically significant correlations with lymph node status, tumor depth, and specific primary tumor location. Perineural invasion was more likely seen in tumors located at the tongue or floor of the mouth. Tumors with PNI had deeper depth of invasion 15.9±10.9mm versus 10.2±10.0 mm (p<0.001). Tumors with PNI had higher mean total number of positive nodes, 2.85±5.23versus 0.83±1.80 (p<0.001).

Conclusions

Perineural invasion is statistically correlated with tongue and floor of the mouth subsites within the oral cavity, as well as, larger tumors, deeper tumors, and disease which has progressed to the lymph nodes. Whether this correlation represents causation in any either direction remains unknown.

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