The significance of perineural invasion in early-stage cervical cancer

Karim S. Elsahwi*, Emma Barber, Jessica Illuzzi, Natalia Buza, Elena Ratner, Dan Arin Silasi, Alessandro D. Santin, Masoud Azodi, Peter E. Schwartz, Thomas J. Rutherford

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Introduction Cervical cancer spreads directly and through lymphatic and vascular channels. Perineural invasion is an alternative method of spread. Several risk factors portend poor prognosis and inform management decisions regarding adjuvant therapy. Objective To evaluate the incidence and significance of PNI in early cervical cancer. Methods Retrospective chart review of early-stage cervical cancer patients (IA-IIA) from 1994 to 2009. Results One hundred ninety two patients were included, 24 with perineural invasion in the cervical stroma (cases) and 168 without (controls). The mean age of the cases was 53 years, versus 45.9 in the controls (P = 0.01). PNI was associated with more adjuvant therapy (P = 0.0001), a higher stage (P = 0.005), a larger tumor size (≥ 4 cm) (P < 0.0001), lymphovascular space invasion (P = 0.002), parametrial invasion (P < 0.0001) and more tumor extension to the uterus (P = 0.015). On multivariate analysis using an adjusted hazard ratio, risk factors for recurrence included grade (HR, 95% CI; 3.61, 1.38-9.41) and histopathology (HR, 95% CI; 2.85, 100-8.09). Similarly, risk factors for death included grade (HR, 95% CI; 3.43, 1.24-9.49) and histopathology (HR, 95% CI; 3.71, 1.03-13.33). Perineural invasion was not identified as an independent risk factor for either recurrence or death. The mean follow up time was 56 months. There was no significant difference in recurrence (P = 0.601) or over-all survival (P = 0.529) between cases and controls. Conclusion While perineural invasion was found to be associated with multiple high-risk factors, it was not found to be associated with a worse prognosis in early cervical cancer.

Original languageEnglish (US)
Pages (from-to)561-564
Number of pages4
JournalGynecologic oncology
Issue number3
StatePublished - Dec 2011


  • Adjuvant therapy
  • Cervical cancer
  • Perineural invasion
  • Risk factors

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology


Dive into the research topics of 'The significance of perineural invasion in early-stage cervical cancer'. Together they form a unique fingerprint.

Cite this