PERINEURAL INVASION AND WORST PATTERN OF INVASION AN IMPORTANT PREDICTOR FOR RECURRENCE AND NODAL METASTASIS

Abstract

Background Prognostic implications for the head and neck squamous cell carcinoma (HNSCC) are related to many clinicopathologic parameters. Recent advancement in histopathologic assessment has led to the inclusion of perineural invasion (PNI) and worst pattern of invasion (WPOI) for staging and management of HNSCC as important prognostic parameters. Objective To assess the relationship of PNI and WPOI to lymph node metastasis including skip metastasis, risk of recurrence, and death in the patients with HNSCC. Methods Patients undergoing primary salvage surgery for HNSCC were enrolled in this prospective 1-year follow-up study from January 2019 to January 2020 (mean age 45.84 + 10.59 years). Clinicopathologic parameters of age, sex, size, site, staging, grading, histologic variant, depth of invasion, lymphovascular invasion, WPOI, extracapsular spread, nodal metastasis, recurrence, and skip lesions were assessed at a confidence level of 95% with a P value Results PNI was seen to be positive in 47.8% of cases and WPOI was seen in 70.2% of cases; in addition, 44.7% had positive nodal metastasis. Recurrence and death were seen in 10.6% cases and skip lesions in only 4.3%. A significant association was seen between PNI and recurrence (P = .02) and also between WPOI and nodal metastasis (P Conclusions WPOI is significantly related to nodal metastasis and PNI is significantly related to recurrence. Patients with PNI and WPOI are at increased risk of recurrence and nodal metastasis and will require aggressive treatment and management to improve prognosis.