Perineural invasion is a valuable prognostic factor in advanced stage and/or Node (+) cervical cancer

Background: Perineural invasion (PNI) is correlated with adverse survival in several malignancies, but its significance cervical cancer remains to be clearly defined. The objective of this study was to determine the association between PNI status and clinical outcomes in clinically localized surgically treated cervical cancers. Materials and Methods: We reviewed clinical records and pathology slides of 111 patients with cervical cancer treated with surgery at a single academic center. PNI was evaluated for presence, number of foci per slide, involved largest nerve size, and topographically (intratumoral vs. extratumoral). Association with these parameters, clinicopathologic characteristics and survival were analyzed. Results: The analysis demonstrated that PNI in cervical cancer was significantly correlated with parametrial invasion, tumor size, resection margin involvement, lymphovascular invasion, lymph node (LN) metastasis, depth of stromal invasion, necrosis, and higher stage disease (P < 0.005). Similarly, PNI density and mean size of the nerve involved were also associated with advanced stage (P < 0.005). In the multivariate analysis, PNI was not an independent prognostic factor for disease-free and overall survival. However, in the advanced stage cases and LN (+) cases, PNI is significantly associated with lower overall survival (43 vs. 58 months and 36 vs. 60 months, respectively, P < 0.005). Conclusions: The presence of PNI is accompanied by high-risk factors for recurrence. Overall survival rate is significantly reduced in PNI (+) patients. Although PNI itself is not an independent prognostic factor, PNI has a significant prognostic impact on overall survival in patients with advanced stage and/or Node (+) cervical cancer.