Perineural invasion predicts poor prognosis in oral squamous cell carcinoma: A systematic review and meta-analysis.
Luqing Erik Zhang, Yihan Guo, Manabu Yamazaki et al.
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In 30 seconds
This systematic review and meta-analysis assessed whether perineural invasion (PNI) is associated with clinical outcomes in oral squamous cell carcinoma (OSCC). It included 57 studies with 23,580 patients and pooled hazard ratios from multivariable analyses. PNI was associated with worse overall survival (HR = 1.67; 95% CI: 1.49-1.87), disease-free survival and disease-specific survival, and greater risk of local recurrence. Subgroup and sensitivity analyses supported consistent associations, although moderate publication bias was reported for overall, disease-free, and disease-specific survival.
Key findings
- PNI was associated with worse overall survival (HR = 1.67; 95% CI: 1.49-1.87).
- PNI was associated with worse disease-free survival (HR = 1.71; 95% CI: 1.59-1.84) and disease-specific survival (HR = 1.52; 95% CI: 1.35-1.72).
- PNI was associated with increased local recurrence risk (HR = 2.68; 95% CI: 1.70-4.24).
- Subgroup and sensitivity analyses supported consistent associations; moderate publication bias was noted for OS, DFS, and DSS.
Why it matters
PNI is associated with several clinically important adverse outcomes in OSCC, not only survival but also local recurrence. Recognising this prognostic signal may help inform risk assessment and discussions of management, while the observational evidence does not establish that PNI-directed treatment changes outcomes.
What to keep in mind
The meta-analysis reported moderate publication bias for overall, disease-free, and disease-specific survival. It also identified a need to standardize PNI diagnostic methods.