PROGNOSTIC-SIGNIFICANCE OF VASCULAR AND PERINEURAL INVASION IN CANCEROF THE LARYNX

Purpose: Perineural and vascular invasion are generally recognized as poor prognostic factors in cancer. The authors report the prognostic s ignificance of perineural and vascular invasion in cancer of the laryn x. Materials and Methods: The laryngectomy specimens of 94 patients wi th squamous cell carcinoma of the larynx were analyzed histopathologic ally for vascular and perineural invasion. Prognostic significance of vascular and perineural invasion was evaluated related to the cervical lymph node metastasis, recurrence, and disease-free survival. Results : Vascular invasion significantly influences cervical lymph node metas tasis for supraglottic tumors, yet not for glottic and transglottic tu mors. Perineural invasion has marginal significance in cases of cervic al lymph node metastasis of supraglottic tumors; it has no significanc e in cases of cervical lymph node metastasis of glottic and transglott ic tumors. Vascular invasion significantly increases local and regiona l recurrence rate, but not distant metastasis rate. Perineural invasio n significantly increases local recurrence rate, but not regional recu rrence and distant metastasis rate. The disease-free survival is signi ficantly shortened by the presence of vascular and perineural invasion . According to multivariant analysis, neither vascular nor perineural invasion significantly effects the disease-free survival independently (P > .15). The presence of vascular invasion significantly affects th e recurrence independently (P = .045). The presence of vascular invasi on significantly reduces the interval between surgery and the developm ent of recurrence (P = .013). Conclusion: The presence of vascular and perineural invasion should be checked in every laryngectomy specimen because both have a significant prognostic value; both influence the d isease-free survival and recurrence significantly. Vascular invasion s ignificantly increase cervical lymph node metastasis of supraglottic t umors; perineural invasion has only marginally significant effect on c ervical lymph node metastasis of supraglottic cancers. Vascular invasi on plays an independent role in determining the recurrence. Copyright (C) 1998 by W.B. Saunders Company.