Refining Postoperative Radiotherapy in Early-Stage Oral Squamous Cell Carcinoma: Impact of Perineural and Lymphovascular Invasion.
Journal
Annals of surgical oncology
ISSN
1534-4681
Date Issued
2026-02-16
Author(s)
Huang, Tung-Yun
Liao, Li-Jen
Cheng, Yu-Ping
Hsu, Wan-Lun
Chang, Chun-Wei
Abstract
Background: The prognostic significance of perineural invasion (PNI) and lymphovascular invasion (LVI) in early-stage oral squamous cell carcinoma (OSCC) remains uncertain. The role of postoperative radiotherapy (PORT) in this subgroup is debated. This study aimed to clarify the clinical impact of PNI/LVI and determine the effect of PORT across risk-stratified subsets of early-stage OSCC.
Methods: We retrospectively analyzed 6,121 patients with pT1-2N0M0 OSCC from the Taiwan Cancer Registry (2018-2022). Patients were categorized into Group A (PNI-/LVI-) and Group B (PNI+ and/or LVI+). Clinicopathological characteristics, survival outcomes, and the effect of PORT were assessed using multivariable analysis and propensity score matching (PSM).
Results: The PNI/LVI positivity occurred in 13.5% of patients and was independently associated with poorer differentiation, greater depth of invasion (> 5 mm), T2 classification, tongue subsite, lower BMI, and female sex. Group B patients exhibited significantly lower overall survival (HR 1.45, p = 0.001) and disease-free survival (HR 1.44, p < 0.001), with inferior locoregional control versus Group A. PORT significantly improved locoregional control in Group B (p = 0.005), but no overall or disease-free survival benefit was observed, likely due to effective salvage surgery. In contrast, in Group A, PORT offered no benefit and was associated with worse outcomes.
Conclusions: Perineural invasion and/or LVI represent key adverse prognosticators in early-stage OSCC. Postoperative radiotherapy selectively enhances locoregional control in intermediate-risk patients, but survival outcomes remain unaffected. A risk-adapted therapeutic approach is warranted, tailoring PORT to patients with adverse features and avoiding overtreatment in low-risk cases.
Subjects
Disease control and survivals
Early stage
Locoregional recurrence
Lymphovascular invasion
Oral squamous cell carcinoma
Perineural invasion
Postoperative adjuvant radiotherapy
Publisher
Springer Science and Business Media Deutschland GmbH
Type
journal article