Background/Objectives:Perineural (PnI), lymphatic (LI), and vascular invasion (VI) in tumor specimens are supposed to worsen the clinical course of oral squamous cell carcinoma (OSCC) and negatively influence survival outcomes. Despite this, these histologic features have not been implemented in the international staging recommendation for OSCC and their prognostic role remains questionable due to inconsistent findings in the related literature.Methods:To investigate the impact of PnI, LI, and VI on oral cancer-specific (OCSS), recurrence-free (RFS), and overall survival (OS), we hypothesized that these histologic features are independent risk factors for poor survival and therefore considered within a prospectively maintained single-center cohort of patients with OSCC. LI and VI were assessed together and reported as lymphovascular invasion (LVI).Results:This study included 439 patients with primary OSCC. Sixty-nine Patients (21.9%) had at least one of the two risk factors. Within the 5-year follow-up period, 61 of these patients (64%) died, and 30 patients (31%) developed locoregional recurrences. Both perineural and lymphovascular invasion were strongly correlated with the presence of lymph node metastasis. PnI and LVI were investigated separately using an adjusted Cox’s proportional hazards regression model. In addition to higher tumor size and the presence of nodal disease (higher stage) the presence of LVI was associated with poor OS, OCSS, and RFS on multivariate analysis, while PnI was associated with reduced OS. In stage III/IV postoperative radiotherapy improved survival in patients with PnI but not with LVI.Conclusions:We conclude that the evidence of LVI in tumor specimens should be considered a high-risk factor when planning adjuvant treatment and monitoring patients with OSCC.
背景/目的：肿瘤标本中的神经周围侵犯（PnI）、淋巴管侵犯（LI）和血管侵犯（VI）被认为会恶化口腔鳞状细胞癌（OSCC）的临床病程并对生存结局产生负面影响。尽管如此，这些组织学特征尚未被纳入OSCC的国际分期建议中，且由于相关文献中的发现不一致，其预后作用仍存疑。方法：为探究PnI、LI和VI对口腔癌特异性生存（OCSS）、无复发生存（RFS）和总生存（OS）的影响，我们假设这些组织学特征是生存不良的独立风险因素，并据此在一个前瞻性维护的OSCC患者单中心队列中进行了考察。LI和VI被合并评估并报告为淋巴血管侵犯（LVI）。结果：本研究纳入了439例原发性OSCC患者。其中69例患者（21.9%）至少具有两种风险因素之一。在5年随访期内，这些患者中有61例（64%）死亡，30例（31%）出现局部区域复发。神经周围侵犯和淋巴血管侵犯均与淋巴结转移的存在密切相关。通过调整后的Cox比例风险回归模型分别分析了PnI和LVI。在多变量分析中，除了较大的肿瘤体积和淋巴结病变（更高分期）外，LVI的存在与较差的OS、OCSS和RFS相关，而PnI则与OS降低相关。在III/IV期患者中，术后放疗改善了伴有PnI患者的生存，但对伴有LVI的患者则无此效果。结论：我们得出结论，在规划辅助治疗和监测OSCC患者时，应将肿瘤标本中LVI的证据视为一个高风险因素。
肿瘤(癌症)患者之家