Annals of Surgical Oncology

, Volume 19, Issue 6, pp 1995–2002

Treatment for T1-2 Oral Squamous Cell Carcinoma with or Without Perineural Invasion: Neck Dissection and Postoperative Adjuvant Therapy

  • Shyh-Kuan Tai
  • Wing-Yin Li
  • Muh-Hwa Yang
  • Shyue-Yih Chang
  • Pen-Yuan Chu
  • Tung-Lung Tsai
  • Yi-Fen Wang
  • Peter Mu-Hsin Chang
Head and Neck Oncology

DOI: 10.1245/s10434-011-2182-5

Cite this article as:
Tai, S., Li, W., Yang, M. et al. Ann Surg Oncol (2012) 19: 1995. doi:10.1245/s10434-011-2182-5

Abstract

Background

Although perineural invasion (PNI) has been a poor prognostic factor for head and neck cancers, few studies have focused on oral squamous cell carcinoma (OSCC). The independent significance of PNI in early T1-2 OSCC and the benefit of treatment modification based on PNI status have not been assessed. This study investigated the role of PNI in T1-2 OSCC patients, with focus on the controversial issues of neck management and postoperative adjuvant therapy.

Methods

PNI status was re-reviewed under hematoxylin and eosin staining in tumors of 307 consecutive T1-2 OSCC patients. Oncologic and survival outcomes were analyzed by univariate and multivariate analyses.

Results

PNI was identified in 84 (27.4%) patients, correlating with several established poor prognostic factors. In multivariate analysis, PNI remained an independent predictor for neck metastasis, neck recurrence, and a worse 5-year disease-specific survival. Elective neck dissection contributed to a significantly better 5-year disease-specific survival only in cN0 patients with PNI-positive tumors (P = 0.0071) but not in those with PNI-negative tumors (P = 0.3566). In low-risk patients who were treated by surgery alone, including neck dissection, the 5-year disease-specific survival rates were almost the same in those with PNI-positive tumors and those with PNI-negative tumors (92.0 vs. 92.9%; P = 0.9104).

Conclusions

Elective neck dissection is indicated for cN0 patients with PNI-positive tumors for the efficacy of improving disease-specific survival as well as neck control. However, low-risk PNI-positive patients who undergo neck dissection do not need postoperative adjuvant therapy, because the residual risk from PNI is minimal.

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Shyh-Kuan Tai
    • 1
    • 2
    • 3
  • Wing-Yin Li
    • 4
  • Muh-Hwa Yang
    • 2
    • 5
  • Shyue-Yih Chang
    • 1
    • 2
  • Pen-Yuan Chu
    • 2
  • Tung-Lung Tsai
    • 2
  • Yi-Fen Wang
    • 2
  • Peter Mu-Hsin Chang
    • 2
    • 5
  1. 1.Department of OtolaryngologyNational Yang-Ming UniversityTaipeiTaiwan
  2. 2.Department of OtolaryngologyTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.Institute of Clinical Medicine, National Yang-Ming UniversityTaipeiTaiwan
  4. 4.Department of PathologyTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.Division of Medical Oncology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan