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Updated: Nov 14, 2025
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A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
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Perineural Invasion As the Sole Pathologic Risk Factor After Surgical Resection for Head and Neck Squamous Cell
Ryan T Hughes1, Joshua Farris1, Cole Steber1
1Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, USA.
Cureus
|March 11, 2021
Summary
Perineural invasion (PNI) is a rare sole risk factor in head and neck squamous cell carcinoma (HNSCC) after surgery. This study found no significant difference in outcomes with or without PNI, but postoperative radiotherapy remains standard care.
Area of Science:
- Oncology
- Head and Neck Surgery
- Radiation Oncology
Background:
- Postoperative radiotherapy (PORT) is standard for head and neck squamous cell carcinoma (HNSCC) with pathologic risk factors (pRFs).
- Perineural invasion (PNI) is a known pRF, but its role as the sole risk factor in otherwise low-risk HNSCC is unclear.
- Assessing PNI as an isolated risk factor is crucial for refining adjuvant treatment strategies.
Purpose of the Study:
- To evaluate the prognostic significance of perineural invasion (PNI) as the sole pathologic risk factor in patients with resected, otherwise low-risk head and neck squamous cell carcinoma (HNSCC).
- To compare locoregional control (LRC), overall survival (OS), and disease-specific survival (DSS) between patients with and without PNI.
- To explore the impact of adjuvant therapies, specifically PORT, in this select patient group.
Main Methods:
- Retrospective analysis of 85 HNSCC patients treated with primary surgical resection (2013-2018) who had PNI as the only identified pRF.
- Patients with other pRFs (e.g., advanced T-stage, positive margins, LVI, ENE) were excluded.
- Locoregional control (LRC), overall survival (OS), and disease-specific survival (DSS) were estimated and compared between PNI-positive and PNI-negative groups, and by receipt of PORT.
Main Results:
- Only 8 patients (9.4%) had PNI as the sole pRF; these patients were more likely to have oral cavity cancer and receive PORT.
- No significant differences in 2- and 5-year LRC, OS, or DSS were observed between PNI-positive and PNI-negative groups.
- The utility of PORT could not be definitively assessed due to small sample size, though no PNI-positive patients who did not receive PORT experienced locoregional failure.
Conclusions:
- Perineural invasion (PNI) as the sole pathologic risk factor in resected, otherwise low-risk head and neck squamous cell carcinoma (HNSCC) is rare.
- In this cohort, PNI alone did not significantly impact locoregional control or survival outcomes.
- Postoperative radiotherapy (PORT) remains the standard of care for patients with PNI, but further studies are needed to clarify its specific benefit in this context.
