The role of perineural invasion in parotid malignancy outcomes: A systematic review and meta-analysis. (July 2022)

• Record Type: Journal Article
• Authors: Kazemian, Elycia; Solinski, Mark; Adams, William; Moore, Mary; Thorpe, Eric J
• Is Part Of: Oral oncology. Volume 130(2022)
• Publication Date: 2022-07
• Subjects: Salivary neoplasms -- Parotid tumor -- Survival -- Mortality -- Outcomes; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2022.105937
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Parotid neoplasm. Perineural invasion. Outcomes. Systematic review. Meta-analysis. Abstract: Purpose: At present, perineural invasion is used as a histologic indicator of aggressive salivary gland disease. In other head and neck malignancies, perineural invasion impacts staging of cancer lesions and therefore affects treatment options. Objective: To compare survival outcomes in primary parotid malignancies with and without perineural invasion. A systematic review pooled data from the scientific literature in patients with any primary parotid malignancy to investigate the prognosis of those with perineural invasion. Data Sources: PubMed (Medline), Scopus and Cochrane databases were queried from inception to July 2020 without any initial search constraints. Additional publications were included from review of pertinent articles. Study Selection: Our inclusion criteria included primary parotid cancers with reported perineural invasion on survival outcomes. Exclusion criteria were non-English language text, non-human studies, reviews, textbooks, abstracts, case reports and case series. Two authors independently reviewed articles for inclusion. Of the initial 465 records, 83 articles were reviewed in full to yield a final collection of 14 studies. Data Extraction and Synthesis: PRISMA-p guidelines were used in the reporting of our studies. A MOOSE Checklist was also used. MINORS criteria were applied to assess risk of bias. Random-effects models were used to estimate pooled effect sizes. No institutional review board review was needed for our study. Main Outcomes and Measures: Primary study outcomes were set prior to data collection and included overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and distant-metastasis-free survival (DMFS) in patients with and without perineural invasion. Results: Fourteen studies contributed to this meta -analysis. Compared to patients without perineural invasion, the pooled rate of mortality ( HR = 3.64), time to recurrence ( HR = 3.56), disease-specific mortality ( HR = 2.77) and distant metastasis ( HR = 3.84) was significantly higher for patients with PNI (all p <.001). Controlling for perineural invasion status, no moderator was associated with these survival outcomes (all p >.05). Given the clinical severity of perineural invasion, few studies were null as shown in a panel of publication bias plots. Conclusion: Perineural invasion portends a poor survival outcome in patients with parotid malignancies. Level of Evidence: 1.