Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus-Positive Oropharyngeal Carcinoma.

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Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus-Positive Oropharyngeal Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2017 Oct 26;:

Authors: Albergotti WG, Schwarzbach HL, Abberbock S, Ferris RL, Johnson JT, Duvvuri U, Kim S

Abstract
Importance: Recently, the American Joint Committee on Cancer (AJCC) updated its staging system for human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). The prognostic significance of perineural invasion (PNI) and angiolymphatic invasion (ALI) within this staging system is unknown.
Objective: To examine the prevalence and prognostic significance of PNI and ALI in HPV-positive OPSCC.
Design, Setting, and Participants: A retrospective review was performed of all patients with HPV-positive OPSCC treated surgically at the University of Pittsburgh Medical Center from January 1, 1980, through December 31, 2015, with at least 1 year of follow-up or death within 1 year.
Interventions: Surgical treatment of HPV-positive OPSCC.
Main Outcomes and Measures: The prevalence of PNI and ALI was determined from review of pathologic data, and Kaplan-Meier curves were generated for overall survival and disease-free survival when stratified by the presence of PNI and ALI. Multivariate analysis was performed using a Cox proportional hazards regression model.
Results: A total of 201 patients met the inclusion criteria (mean [SD] age, 57.4 [9.0] years; 79.6% [3.0%] male, and 20.4% [3.0%] female). Perineural invasion was identified in 32 of 201 primary specimens (15.9%), whereas ALI was identified in 74 of 201 primary specimens (36.8%). Both were significantly associated with increasing T stage. On multivariate analysis, the presence of at least 1 risk factor was significantly associated with overall and disease-free survival (overall hazard ratio, 2.78; 95% CI, 1.15-6.76; disease-free survival hazard ratio, 3.10; 95% CI, 1.17-8.23). Among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of at least 1 risk factor was associated with worse overall survival (hazard ratio, 11.7; 95% CI, 1.2-111.7).
Conclusions and Relevance: Both PNI and ALI were commonly found in HPV-positive OPSCC, with increasing prevalence as T stage increased. The presence of at least 1 risk factor was associated with worse overall and disease-free survival. Specifically, among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of ALI or PNI may suggest a poorer prognosis.

PMID: 29075776 [PubMed - as supplied by publisher]

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