Perineural invasion in early-stage cervical cancer: detection and influence on prognosis

Purpose: To compare staining methods for detecting perineural invasion (PNI) in early-stage cervical cancer and assess the influence of PNI on survival. Materials and Methods: The authors retrospectively analysed data on 300 patients treated between 2010 and 2014 for cervical cancer in Stages Ia2-IIb. Rates of PNI detection using Hematoxylin-Eosin (HE) or anti-S-100 protein staining were compared. Influence of PNI on disease-free survival (DFS) and overall survival (OS) were assessed in all patients and in subgroups based on use of adjuvant therapy and nerve-sparing radical hysterectomy (NSRH). Results: Among the 300 patients, HE staining detected PNI in 38 (12.7%) and anti-S-100 staining detected PNI in 45 (15.0%, p = 0.016). PNI was associated with significantly shorter DFS (p = 0.015) and OS (p = 0.020), but it was not an independent risk factor for poor DFS or OS. Significantly higher proportions of patients with PNI received adjuvant radiotherapy or chemo-radiotherapy than patients without PNI (p < 0.001), but the two groups of patients showed similar DFS (p = 0.293) and OS (p = 0.329). Conclusion: Patients with PNI showed significantly longer DFS if they received adjuvant therapy (p = 0.039). Patients who underwent NSRH showed similar DFS and OS as those who did not, regardless of their PNI status. Anti-S-100 staining detects PNI better than HE in patients with early-stage cervical cancer. PNI is associated with poor survival, which can be improved through adjuvant therapy. NSRH does not appear to adversely affect survival of patients with or without PNI.

Cervical cancer; Perineural invasion; Staining method; Prognosis.

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