This study aimed to establish and validate the efficacy of a nomogram model, synthesized through the integration of multi-parametric magnetic resonance radiomics and clinical risk factors, for forecasting perineural invasion in rectal cancer. We retrospectively collected data from 108 patients with pathologically confirmed rectal adenocarcinoma who underwent preoperative multiparametric MRI at the First Affiliated Hospital of Bengbu Medical College between April 2019 and August 2023. This dataset was subsequently divided into training and validation sets following a ratio of 7:3. Both univariate and multivariate logistic regression analyses were implemented to identify independent clinical risk factors associated with perineural invasion (PNI) in rectal cancer. We manually delineated the region of interest (ROI) layer-by-layer on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) sequences and extracted the image features. Five machine learning algorithms were used to construct radiomics model with the features selected by least absolute shrinkage and selection operator (LASSO) method. The optimal radiomics model was then selected and combined with clinical features to formulate a nomogram model. The model performance was evaluated using receiver operating characteristic (ROC) curve analysis, and its clinical value was assessed via decision curve analysis (DCA). Our final selection comprised 10 optimal radiological features and the SVM model showcased superior predictive efficiency and robustness among the five classifiers. The area under the curve (AUC) values of the nomogram model were 0.945 (0.899, 0.991) and 0.846 (0.703, 0.99) for the training and validation sets, respectively. The nomogram model developed in this study exhibited excellent predictive performance in foretelling PNI of rectal cancer, thereby offering valuable guidance for clinical decision-making. The nomogram could predict the perineural invasion status of rectal cancer in early stage.

OBJECTIVE: To develop and validate a radiomics nomogram utilizing CT data for predicting perineural invasion (PNI) and survival in gastric cancer (GC) patients.
METHODS: A retrospective analysis of 408 GC patients from two institutions: 288 patients from Institution I were divided 7:3 into a training set (n = 203) and a testing set (n = 85); 120 patients from Institution II served as an external validation set. Radiomics features were extracted and screened from CT images. Independent radiomics, clinical, and combined models were constructed to predict PNI. Model discrimination, calibration, clinical utility, and prognostic significance were evaluated using area under the curve (AUC), calibration curves, decision curves analysis, and Kaplan-Meier curves, respectively.
RESULTS: 15 radiomics features and three clinical factors were included in the final analysis. The AUCs of the radiomics model in the training, testing, and external validation sets were 0.843 (95% CI: 0.788-0.897), 0.831 (95% CI: 0.741-0.920), and 0.802 (95% CI: 0.722-0.882), respectively. A nomogram was developed by integrating significant clinical factors with radiomics features. The AUCs of the nomogram in the training, testing, and external validation sets were 0.872 (95% CI: 0.823-0.921), 0.862 (95% CI: 0.780-0.944), and 0.837 (95% CI: 0.767-0.908), respectively. Survival analysis revealed that the nomogram could effectively stratify patients for recurrence-free survival (Hazard Ratio: 4.329; 95% CI: 3.159-5.934; P < 0.001).
CONCLUSIONS: The radiomics-derived nomogram presented a promising tool for predicting PNI in GC and held significant prognostic implications.
RESULTS: The nomogram functioned as a non-invasive biomarker for determining the PNI status. The predictive performance of the nomogram surpassed that of the clinical model (P < 0.05). Furthermore, patients in the high-risk group stratified by the nomogram had a significantly shorter RFS (P < 0.05).

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignant tumor with a high metastatic potential. Perineural invasion (PNI) occurs in the early stages of PDAC with a high incidence rate and is directly associated with a poor prognosis. It involves close interaction among PDAC cells, nerves and the tumor microenvironment. In this review, we detailed discuss PNI-related pain, six specific steps of PNI, and treatment of PDAC with PNI and emphasize the importance of novel technologies for further investigation.

UNASSIGNED: The presence of lymphovascular invasion (LVI), perineural invasion (PNI) and extranodal extension (ENE) have shown adverse outcomes in oral squamous cell carcinoma (OSCC). This study evaluated the impact of LVI, PNI and ENE, individually and in combination, on survival outcomes in OSCC.
UNASSIGNED: A retrospective analysis of a prospectively maintained oral cancer database was done from January 2017 to March 2023. All consecutive OSCC patients who underwent curative intent surgery were included. The triple-positive group was defined by the presence of all three features (LVI/PNI/ENE), while the double-positive group had the presence of two features. The disease-free survival (DFS) and overall survival (OS) analysis was done between different study groups.
UNASSIGNED: A total of 255 patients were included in the analysis. The LVI, PNI and ENE positivity was 13%, 26% and 11%, respectively. There were 19 patients (7%) with double-positive and ten patients (4%) with triple-positive disease. The triple-positive group had lower DFS than non-triple-positive (0% vs 57%, p-value 0.001) and lower OS (0% vs 72%, p-value 0.003). The median DFS and OS of the triple-positive group were eight months and 24 months, respectively. Similarly, the double-positive group also had statistically significant inferior DFS (p-value 0.007) and OS (p-value 0.002) compared to the single-positive/triple-negative group.
UNASSIGNED: The triple-positive disease had poor outcomes, with no patients achieving disease-free or overall survival at the 5-year follow-up. The presence of multiple adverse factors necessitates modification of adjuvant therapy and therapeutic strategy, which may enhance survival outcomes.

UNASSIGNED: The purpose of this study was to analyse the independent prognostic significance of perineural invasion (PNI) on local recurrence (LR) in patients with oral squamous cell carcinoma (OSCC) managed primarily with surgery.
UNASSIGNED: Clinical and histopathological data of 195 patients with OSCC were analysed retrospectively to identify risk factors associated with PNI and to evaluate its significant correlation with local recurrence, overall survival (OS) and recurrence free survival (RFS).
UNASSIGNED: Patients were followed for a mean period of 39.5 ± 1.376 months and median 35 months. PNI was found in 57 patients (29.2%). PNI correlated with tongue subsite (p = 0.001), nodal metastasis (p < 0.000), depth of invasion (DOI) (p = 0.002), stage (p = 0.013) and adjuvant therapy (p < 0.001). Mean time to recurrence with PNI was significantly shorter (p = 0.002).Multivariate analysis did not establish significant relationship between PNI and LR. Kaplan-Meier curve did not show statistical significance with OS (p = 0.085) or RFS (p = 0.110).
UNASSIGNED: PNI remains an aggressive factor for nodal metastasis mandating neck management for regional control. Though PNI showed no statistical significance with LR, time to recurrence in PNI positive patients were significantly shorter. Hence, close follow-up regimen becomes necessary.

UNASSIGNED: Cutaneous squamous cell carcinoma (cSCC) stands as the second most prevalent non-melanoma skin cancer worldwide, comprising approximately 20% of all cutaneous malignancies. Determining its precise incidence poses challenges; however, reports indicate a global increase in its prevalence. At the time of diagnosis, the majority of cSCCs are localized, resulting in favorable 5-year cure rates surpassing 90%. Nevertheless, a subset of patients (3-7%) encounters locally advanced or metastatic cSCC, leading to substantial morbidity and mortality. The risk of metastasis ranges from 0.1% to 9.9%, carrying an associated mortality risk of 2.8%. Factors influencing recurrence, metastasis, and disease-specific mortality underscore the significance of perineural invasion (PNI) as a key indicator. Patients with PNI may manifest clinical symptoms and/or radiologic signs of PNI, while the majority remain asymptomatic, and PNI is frequently identified upon histologic examination. Despite its lower frequency compared to other cancer types, PNI serves as a recognized adverse prognostic factor for cSCC. Surgery is the elective treatment for these patients, while the role of adjuvant radiotherapy (ART) is yet contentious and have not been conclusively assessed, particularly in clear surgical margin. Prospective comparative studies are required to comprehensively evaluate the benefit and the risks of ART for cSCC and PNI patients.

UNASSIGNED: To clarify whether self-expandable metallic stent (SEMS) placement for obstructive colorectal cancer (CRC) increases perineural invasion (PNI), thereby worsening the prognosis.
UNASSIGNED: In total, 1022 patients with pathological T3 or T4 colon or rectosigmoid cancer who underwent resection were retrospectively reviewed. The study patients were divided into a no obstruction group (n=693), obstruction without stent group (n=251), and obstruction with stent group (n=78), and factors demonstrating an independent association with PNI, the difference in PNI incidence and severity between groups, and the association between PNI and the duration from SEMS placement to surgery were investigated. Survival analysis was performed for each group.
UNASSIGNED: On multivariate analysis, SEMS placement (hazard ratio [HR]: 2.08) was independently associated with PNI whereas SEMS placement was not. PNI occurred in 39%, 45%, and 68% of the no obstruction, obstruction without stent, and obstruction with stent group, respectively. In the obstruction with stent group, the proportion of PNI was not associated with the duration from SEMS placement to surgery. Extramural PNI, an advanced form of PNI, demonstrated no increase with increasing interval. The five-year OS was 86.3%, 76.7%, and 73.1% in no obstruction, obstruction without stent, and obstruction with stent group, respectively. On multivariate analysis, obstruction was an independent risk factor of decreased OS (HR: 1.57) whereas SEMS placement was not.
UNASSIGNED: The prognosis was comparable between patients with SEMS placement and those with an obstruction who did not undergo SEMS placement, thus demonstrating that SEMS is a viable, therapeutic option for BTS.

Oral carcinoma is a common disease that poses challenges in treatment management, especially for advanced cases. Adjuvant therapies, such as radiation and chemoradiation therapy, are typically used for advanced oral cancer patients. However, there is uncertainty regarding the use of adjuvant therapy for early-stage patients with certain soft histological parameters. The UICC manual of clinical oncology suggests that adjuvant therapy for such parameters is desirable but not essential. These parameters include perineural invasion, lymphovascular invasion, single nodal positivity, and patterns of invasion, which complicate the decision-making process for including adjuvant therapy. This review aims to provide evidence-based literature for effectively managing this patient group and developing treatment protocols based on current evidence.

Background and Objectives: Renal cell carcinomas and upper tract urothelial carcinomas are types of malignancies that originate in the kidneys. Each of these examples shows an increasing trend in the frequency and the mortality rate. This study aims to comprehensively define carcinomas by analyzing clinical, paraclinical, and histological aspects to predict aggressiveness and mortality. Materials and Methods: We conducted a retrospective investigation on a group of patients suspected of kidney cancers. Results: We identified 188 cases. We observed a higher mortality rate and older age in individuals with urothelial carcinomas. Anemia, acute kidney injury, hematuria, and perineural invasion were the main risk factors that predicted their mortality. Tumor size in renal cell carcinomas correlates with the presence of necrosis and sarcomatoid areas. Factors that indicate a higher rate of death are older age, exceeding the renal capsule, a lesion that includes the entire kidney, lymphovascular invasion, acute kidney injury, and anemia. Conclusions: Even if they originate at the renal level, and the clinical-paraclinical picture is similar, the histopathological characteristics make the difference. In addition, to these are added the previously mentioned common parameters that can represent important prognostic factors. In conclusion, the characteristics commonly identified in one type of cancer may act as risk factors for the other tumor. The detected data include threshold values and risk factors, making a significant contribution to the existing literature.

Perineural invasion (PNI), the neoplastic invasion of nerves, is an often overlooked pathological phenomenon in cervical cancer that is associated with poor clinical outcomes. The occurrence of PNI in cervical cancer patients has limited the promotion of Type C1 surgery. Preoperative prediction of the PNI can help identify suitable patients for Type C1 surgery. However, there is a lack of appropriate preoperative diagnostic methods for PNI, and its pathogenesis remains largely unknown. Here, we dissect the neural innervation of the cervix, analyze the molecular mechanisms underlying the occurrence of PNI, and explore suitable preoperative diagnostic methods for PNI to advance the identification and treatment of this ominous cancer phenotype.