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Updated: Jul 25, 2026
A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
Refining Postoperative Radiotherapy in Early-Stage Oral Squamous Cell Carcinoma: Impact of Perineural and
Tung-Yun Huang1, Li-Jen Liao2,3, Yu-Ping Cheng4,5
1Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Background:
The prognostic significance of perineural invasion (PNI) and lymphovascular invasion (LVI) in early-stage oral squamous cell carcinoma (OSCC) remains uncertain. The role of postoperative radiotherapy (PORT) in this subgroup is debated. This study aimed to clarify the clinical impact of PNI/LVI and determine the effect of PORT across risk-stratified subsets of early-stage OSCC.
Methods:
We retrospectively analyzed 6,121 patients with pT1-2N0M0 OSCC from the Taiwan Cancer Registry (2018-2022). Patients were categorized into Group A (PNI-/LVI-) and Group B (PNI+ and/or LVI+). Clinicopathological characteristics, survival outcomes, and the effect of PORT were assessed using multivariable analysis and propensity score matching (PSM).
Results:
The PNI/LVI positivity occurred in 13.5% of patients and was independently associated with poorer differentiation, greater depth of invasion (> 5 mm), T2 classification, tongue subsite, lower BMI, and female sex. Group B patients exhibited significantly lower overall survival (HR 1.45, p = 0.001) and disease-free survival (HR 1.44, p < 0.001), with inferior locoregional control versus Group A. PORT significantly improved locoregional control in Group B (p = 0.005), but no overall or disease-free survival benefit was observed, likely due to effective salvage surgery. In contrast, in Group A, PORT offered no benefit and was associated with worse outcomes.
Conclusions:
Perineural invasion and/or LVI represent key adverse prognosticators in early-stage OSCC. Postoperative radiotherapy selectively enhances locoregional control in intermediate-risk patients, but survival outcomes remain unaffected. A risk-adapted therapeutic approach is warranted, tailoring PORT to patients with adverse features and avoiding overtreatment in low-risk cases.
