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.