“Prognostic Value of Perineural Invasion in Oral Cancer: A Retrospective Study”

Abstract

Oral squamous cell carcinoma (OSCC) remains a major global health concern due to its high morbidity and mortality. Perineural invasion (PNI), where cancer cells invade the perineural space, has emerged as a significant factor associated with poor outcomes, including higher recurrence and decreased survival. This study explores the prognostic impact of PNI in OSCC and its potential role in guiding treatment decisions. Materials and Methods:

A retrospective analysis of 150 patients with OSCC treated surgically at Saveetha Dental College between October 2022 and June 2024 was conducted. Data collected included demographics, tumor characteristics, presence of PNI, treatment modalities, and recurrence outcomes. Survival analysis was performed using Kaplan-Meier estimates and Cox proportional hazards models. Results: PNI was present in 40% of cases, predominantly in tumors of the tongue and floor of the mouth. PNI-positive patients had significantly worse overall survival (45% vs. 75%, p < 0.001) and disease-free survival (35% vs. 70%, p < 0.001). PNI was independently associated with poorer outcomes, with hazard ratios of 2.3 for overall survival and 2.6 for disease-free survival. Recurrence rates were higher in PNI-positive patients (60% vs. 30%), and distant metastasis was more frequent (15% vs. 5%). Median time to recurrence was shorter for PNI-positive patients (18 vs. 36 months, p < 0.001). Conclusion:

PNI is a robust prognostic marker in OSCC, significantly associated with worse survival and higher recurrence rates. Its presence should prompt consideration of more aggressive treatment strategies, including wider surgical margins and adjuvant therapies. Routine assessment of PNI is essential for improving OSCC outcomes.

Keywords: Perineural Invasion, Oral Squamous cell carcinoma, Head and neck oncology, Metastasis