Multifocal perineural invasion is a better prognosticator than depth of invasion in oral squamous cell carcinoma

Abstract Objectives Prognostic significance of perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) characterized as unifocal and multifocal was compared to depth of invasion (DOI) and extranodal extension (ENE). Materials and Methods Univariable and multivariable analyses of 861 consecutive patients with OSCC undergoing treatment between 1995 and 2018 were performed, with local failure (LF) and disease‐specific mortality (DSS) as the primary endpoints. Results After adjusting for other adverse histopathological factors and adjuvant therapy, multifocal PNI was associated with a greater risk of LF ( P = .01) and DSS ( P = 0.02) compared to DOI. The effect of multifocal PNI was comparable to the effect of nodal metastases without ENE ( P = 0.02). LF and DSS were not improved by the administration of adjuvant radiotherapy within unifocal or multifocal PNI groups. Conclusion Multifocal PNI is associated with a greater risk of death in OSCC than DOI. Its effect is comparable to that of nodal metastases (without ENE).