Source: Doctor’s Guide (www.docguide.com)
Author: Arushi Sinha

Among patients with early-stage squamous cell carcinomas, those with perineural involvement appear to have lower survival rates compared with patients who have no perineural involvement, according to research presented here at the American Head and Neck Society (AHNS) 7th International Conference on Head and Neck Cancer.

While it is known that perineural invasion by the carcinoma has a negative impact on prognosis for squamous cell carcinomas in general, there is less information on the impact for early-stage oral cancers.

“With perineural invasion, there is a possibility that even very small tumours can be very aggressive,” explained Raquel Moysés, MD, Head and Neck Surgery Department, Sao Paulo University Medical School, Sao Paulo, Brazil.

The retrospective study, presented in a poster session on July 22, examined the progress of 42 patients diagnosed with early-stage squamous cell carcinoma of the oral tongue or of the floor of the mouth. The tumours were stage I or II with no nodal involvement (N0). There were 16 patients with perineural invasion and 26 patients without. The average follow-up time was 49 months.

Study endpoints included clinical and pathological characteristics as well as an analysis of treatment regimens and outcomes data.

When compared with those without perineural involvement, patients with perineural invasion were found to have significantly larger tumour diameter (P = .046) and thickness (P = .002). They also had a higher rate of disease-specific death (P = .015) and lower global survival (P = .019), despite having a higher rate of adjuvant radiotherapy.

In addition, patients with perineural invasion were more likely to be male (P = .008) and have an increased incidence of tobacco exposure (P = .042). Disease-free survival rates were not different between the 2 groups.

Perineural involvement was not a significant predictor of disease-specific death (P = .0275) but did influence global survival rates.

Based on these findings, the authors concluded that even despite more aggressive treatment, patients with perineural involvement had lower global survival rates compared with patients who had no perineural invasion.

“Depending upon the pathological findings, even small, early-stage tumours can result in higher death rates,” summarised Dr. Moysés.

The abstract received an award of distinction from the conference committee.

[Presentation title: Critical Analysis of the Outcome of Early Stage Tongue and Floor of Mouth SCC With Perineural Invasion. Abstract P626]