Impact of perineural invasion in the pathologically N0 neck in oral cavity squamous cell carcinoma

Steven B. Chinn, Matthew E. Spector, Emily L. Bellile, Jonathan B. McHugh, Thomas J. Gernon, Carol R. Bradford, Gregory T. Wolf, Avraham Eisbruch, Douglas B. Chepeha

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Objective. Patients with oral cavity squamous cell carcinoma (OCSCC) undergo adjuvant radiation for pathologically high-risk features including positive nodal disease and extracapsular spread (ECS). In the absence of these high-risk features, our objective was to determine if perineural invasion (PNI) is an independent risk factor and if adjuvant radiation (XRT) improves disease control rates. Study Design. Historical cohort analysis. Setting. Tertiary university hospital. Methods. Eighty-eight OCSCC patients (46 males, 42 females; mean age = 56.7 years; median follow-up = 4.6 years) treated surgically with pathologically N0 (pN0) necks were studied. Overall, 23% (20/88) were pN0/PNI1 and of those with PNI, 70% (14/20) underwent XRT. Survival analysis using Kaplan-Meier followed by multivariable Cox models was performed. Results. Multivariate analysis verified PNI to be associated with worse disease-free interval (DFI) (P = .012) and localregional control (LRC) (P = .005) and perivascular invasion (PVI) associated with worse DFI (P = .05). Among pN0/ PNI1 patients, those who received XRT demonstrated significantly improved DFI (mean = 6.5 years vs 1.7 years; P = .014) and LRC (mean 6.7 years vs 1.9 years; P = .047). There was no improvement in overall survival (P = .68) or disease-specific survival (P = .8) in those receiving XRT. Conclusions. PNI is an independent adverse risk factor in the absence of nodal metastasis and extracapsular spread. We observed a statistically significantly longer DFI and LRC when patients were treated with adjuvant radiation.

Original languageEnglish (US)
Pages (from-to)893-899
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number6
StatePublished - Dec 2013


  • oral cavity
  • perineural invasion
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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