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Updated: Aug 8, 2026
A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
Risk Stratification by Extent of Extranodal Extension and Peri-Neural Invasion in Post-Operative Oral Cavity Squamous
Sambit Swarup Nanda1, Ashutosh Mukherji1, Shubham Dokania1
1Department of Radiation Oncology, Mahamana Pandit MadanMohan Malaviya Cancer Centre (under Homi Bhabha National University, Mumbai), Varanasi, Uttar Pradesh, India.
Background:
The AJCC 8th edition recommends subclassifying extranodal extension (ENE) and perineural invasion (PNI) in oral cavity squamous cell carcinoma (OCSCC), though their prognostic relevance remains uncertain.
Methods:
Post-operative OCSCC patients (2019-2024) receiving adjuvant radiotherapy or chemoradiotherapy with documented ENE and/or PNI were retrospectively analyzed. ENE (microscopic [miENE] vs. macroscopic [maENE]) and PNI (intratumoral [IPNI] vs. extratumoral [EPNI]) were correlated with disease-free survival (DFS), overall survival (OS), and failure patterns using multivariate Cox models.
Results:
Among 410 patients (median follow-up: 33 months), 3-year DFS and OS were 45.6% and 53.2%. ENE subtyping did not impact DFS or OS. EPNI independently predicted inferior DFS (43.3% vs. 49.5%, p = 0.019) and OS (50.2% vs. 57.9%, p = 0.02). Combined EPNI, ENE, and lymph-node ratio > 0.05 identified a very high-risk subgroup.
Conclusion:
ENE subclassification lacked prognostic significance. EPNI predicted worse outcomes and, with ENE or high lymph node ratio, defines an aggressive phenotype warranting treatment intensification.