Perineural invasion/lymphovascular invasion double positive predicts distant metastasis and poor survival in T3–4 oral squamous cell carcinoma

Abstract

Postoperative adjuvant therapy has been indicated by advanced T classification for T3–4 oral squamous cell carcinoma (OSCC) and the significance of perineural invasion (PNI) and lymphovascular invasion (LVI) in treatment for T3–4 OSCC remains unclear. Ninety-eight cumulative patients with T3–4 OSCC who underwent curative surgery between Jan 2002 and Dec 2010 were recruited and analyzed. Twenty-seven (27.6%) patients were PNI/LVI double positive. PNI/LVI double positive demonstrated independent predictive values for higher neck metastasis (LN+), higher distant metastasis (DM) and low 5-year disease-specific survival (DSS) rates (p < 0.001, p = 0.017, and p < 0.001, respectively) after controlling for other pathologic features of the primary tumors. A high DM rate of 33.3% was noted in PNI/LVI double-positive patients. Among the PNI/LVI double negative, single positive to double positive subgroups, increasing LN+, DM rates and decreasing DSS rate were observed. Among the 44 LN+ patients, PNI/LVI double positive remained associated with a markedly high DM rate of 42.9% and a poor 5-year DSS of 27.7%. PNI/LVI double positive plays important roles in prognostication and potential clinical application for T3–4 OSCC by independently predicting LN+, DM, and poor DSS, and can be used as a good marker to select DM high-risk patients for novel adjuvant therapy trials.

The clinicopathological and microrna expression signature associated with lymphovascular invasion in squamous cell carcinoma: A basic descriptive study

“…Histopathologic analysis found poorly‐differentiated tumors in the sample to have the greatest association with LVI, concuring with a well established clinical concept 10,18 . In agreement with Fania et al, 1 ulceration and dysplasia were also dominant features across the sample with severe dysplasia found most frequently in LVI positive cases.…”

“… 4 The presence of lymphovascular invasion is known to be a poor prognostic marker in various cancers including breast, urothelial and oral SCC. 5 , 6 , 7 , 8 , 9 , 10 In addition, the presence of LVI is associated with advanced tumor stage, high grades, lymph node metastasis in these cancers. 10 , 11 , 12 However, the molecular mechanisms mediating this prognostic feature remain undefined.…”

Clinicopathological characteristics predicting advanced stage and surgical margin invasion of oral squamous cell carcinoma: A single‑center study on 10 years of cancer registry data

“…More than one-half of the patients were positive for LVI in the present study. This was similar to a study by Ting et al ( 98 ), which reported that most patients with T3–4 OSCC (44.9%) demonstrated LVI.…”

Role of postoperative chemoradiotherapy in head and neck cancer without positive margins or extracapsular extension: a propensity score-matching analysis

“…Roberts et al analyzed 12,437 cases of postoperative head and neck cancer in the Surveillance, Epidemiology, and End Results database from 2004 to 2012 [ 13 ], and found that the number of lymph nodes, an indicator of lymph node burden, was also correlated with short OS time. LVI and PNI were reported to be other adverse postoperative pathological features with poor survival outcomes [ 14 – 16 ]; however, the association was not observed in the present study, which was possibly caused by the small sample size of the patients with LVI or PNI.…”