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Perineural Invasion in Early-Stage Cervical Cancer: Marker of Aggressive Pathology and Increased Recurrence Risk
Lihua Tan1, Hongyao Li1, Tianyi Liu2
1Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Biomedicines
|March 28, 2026
Summary
Perineural invasion (PNI) in early cervical cancer correlates with adverse features but is not an independent prognostic factor. However, PNI may predict recurrence in select low-risk patients, warranting further investigation into tumor-nerve-immune interactions.
Area of Science:
- Gynecologic Oncology
- Surgical Pathology
- Cancer Genomics
Background:
- Perineural invasion (PNI) is linked to aggressive behavior in many cancers, but its prognostic significance in early-stage cervical cancer is unclear.
- Understanding PNI's role is crucial for refining risk stratification and treatment strategies.
Purpose of the Study:
- To evaluate the clinical significance and prognostic value of PNI in early-stage cervical cancer (FIGO 2009 stage IB-IIA).
- To explore molecular and immune characteristics associated with PNI using multi-omics data.
Main Methods:
- Retrospective analysis of 499 patients treated with radical hysterectomy and pelvic lymphadenectomy.
- Kaplan-Meier and Cox regression for survival analysis.
- Analysis of The Cancer Genome Atlas (TCGA) cohort (286 patients) for transcriptomic, pathway, immune cell, and microRNA profiling.
Main Results:
- PNI detected in 11.6% of cases, associated with larger tumor size, deep stromal invasion, and lymphovascular invasion.
- PNI was not an independent prognostic factor overall but indicated increased recurrence risk in a specific low-risk subgroup.
- TCGA analysis revealed PNI-associated differential gene expression, oncogenic/immune pathway enrichment, increased resting mast cells, and altered microRNA profiles.
Conclusions:
- PNI in early cervical cancer is associated with adverse pathological features and predicts recurrence in a subset of low-risk patients.
- Multi-omics data suggest potential tumor-nerve-immune interactions in PNI.
- External validation is required to determine PNI's utility in guiding postoperative management.
