Perineural invasion is a better prognostic factor than extranodal extension in head and neck cancer

Background The prognostic value of perineural invasion (PNI) in head and neck squamous cell carcinoma (HNSCC) remains controversial. This study investigated the impact of PNI on prognosis in HNSCC. A total of 49 patients with HNSCC who underwent primary surgical treatment were selected for the study. Univariate analysis of the survival curve was performed using the Kaplan-Meier method. Multivariate analysis was carried out by Cox regression. Results PNI was present in 17 of 49 (34.7%) patients. The median follow-up was 18.7 months. The median DFS and OS were 16.6 months and 41.9 months, respectively. Univariate analyses showed that PNI was associated with OS ( p : 0.02), but not with DFS ( p : 0.50). ENE was associated only with DFS in univariate analysis ( p : 0.04), but not OS (yes vs. no; 24.1 vs. 44.6 months, p : 0.21), and in multivariate analysis, ENE lost its significance for DFS ( p : 0.12). Also, PNI was the only significant independent adverse prognostic factor for OS in multivariate analysis ( p : 0.02). The median OS for patients with and without PNI was 17.1 months and 92.1 months, respectively. Conclusion PNI was an independent factor for poor prognosis in patients with HNSCC. The presence of PNI compared to ENE was associated with a greater risk of death in HNSCC. Therefore, it would be appropriate to consider adjuvant therapy in the presence of PNI alone without other adverse risk features.