Perineural Invasion as Worsening Criterion for Salivary Gland Mucoepidermoid Carcinoma

Giulianno Molina de Melo, Giovanni Simoes de Medeiros, Arthur Paredes Gatti, Luiz Henrique Guilherme, Murilo Catafesta das Neves, Marcello Rosano, Fabiano Mesquita Callegari, Jonathon Russell, Marcio Abrahao, Onivaldo Cervantes

Research output: Contribution to journalArticlepeer-review


Mucoepidermoid carcinomas (MECs) are a form of salivary gland malignancy. They are classified according to histological grade and perineural invasion (PNI). In another cancer subtypes, positive-PNI suggests increased poor prognosis; however, the role of isolated positive-PNI salivary gland MEC can still be better investigated as a risk factor. This study investigated whether isolated PNI is independently associated with poor outcomes. Retrospective study, cohort case-series, single-center hospital from 2009 to 2019. Patient demographics, primary tumor, intervention, and survival data are included. Univariate, multivariate, and Kaplan–Meier survival curve analyses were used for comparison.The study group consisted of 32 patients (15 PNI-positive tumors, and 17 PNI-negative tumors), all admitted for surgery. Univariate analysis showed differences in grade (p = 0.038), positive margins (p = 0.034), soft tissue invasion (p < 0.001), pathological stage (p = 0.014), recurrence (p = 0.015), distant metastasis (p = 0.015) and MEC related death (p = 0.015). The risk in PNI-positive patients to develop soft tissue invasion and positive surgical margins was OR = 8.57 and OR = 4.88, respectively. Multivariate analysis found age differences (p = 0.038), with OR = 1.08. The Disease Specific Survival (DSS) was worst in the PNI-positive group (log-rank p-value = 0.0011), where the probability of dying occurred in the 12–24 months period (log-rank p-value = 0.002). PNI-positive salivary gland MEC is an independent prognostic factor, with poor DSS, increased locoregional recurrence, close correlation with a more aggressive pattern of the disease, and should be reviewed as a high grade histological criteria. Our findings may imply changes in the clinical approach with a more aggressive attitude in the overall treatment.

Original languageEnglish (US)
Pages (from-to)6225-6235
Number of pages11
JournalIndian Journal of Otolaryngology and Head and Neck Surgery
StatePublished - Dec 2022


  • Head and neck cancer
  • Local
  • Mucoepidermoid carcinoma
  • Neoplasm recurrence
  • Neoplasms
  • Parotid neoplasms
  • Salivary gland cancer

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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