Are Oral Pain and Otalgia Predictive of Perineural Invasion in Squamous Cell Carcinoma of the Oral Tongue?

Abstract

Squamous cell carcinoma of the oral tongue (SCCOT) has been reported as the most common cancer found in the oral cavity.1 Tongue cancer is often associated with pain and perineural invasion, which is typically defined by tumor cells invading perineural tissues, tracking along nerves, and/or surrounding at least one-third the circumference of nerves.2 The purpose of this study was to determine the association between tongue pain and otalgia and the microscopic identification of perineural invasion in patients with squamous cell carcinoma of the tongue. A retrospective cohort study was performed of patients diagnosed with squamous cell carcinoma of the tongue from January 2013 through June 2019. Patients without a prior history of head and neck cancer, diagnosed and operated for squamous cell carcinoma of the oral tongue by a single surgeon, were included in the study. The primary predictor variables were tongue pain and otalgia (presence vs absence of both). Other variables were patient demographics and TNM staging. The primary outcome variable was the histologic presence of perineural invasion. Chi-square analysis was performed to test for any significant associations between pain, T stage, and overall stage in relation to perineural invasion outcome, and multivariate logistic regression analysis was used to control for cancer staging variables when testing the association between pain and perineural invasion. The sample was composed of 128 subjects of which 76 were male and the mean age was 60 years. Most patients, n = 97 (75.8%), complained of tongue pain, while a minority n = 50 (39.1%) complained of otalgia. Patients with otalgia had 3.15 times higher odds of perineural invasion when controlling for T stage, P = .016, and 3.68 times higher odds of perineural invasion when controlling for overall stage, P = .007. Increasing T stage and overall stage – with the exception of stage II – were also significantly associated with perineural invasion, P = < .05. Our study demonstrates a statistically significant association between preoperative otalgia and perineural invasion in a consecutive group of patients presenting with newly diagnosed tongue cancer.