ArticleAnnals of surgical oncology2026
Refining Postoperative Radiotherapy in Early-Stage Oral Squamous Cell Carcinoma: Impact of Perineural and Lymphovascular Invasion.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe 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.
methodsWe 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).
resultsThe 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.
conclusionsPerineural 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.
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