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Perineural invasion and risk of lymph node metastasis in early-stage operable breast cancer: a large-scale propensity-matched cohort study and meta-analysis

Year: 2026

Type: article

Abstract: Background: Perineural invasion (PNI) is recognized as a prognostic factor in several cancers, but its role in predicting axillary lymph node metastasis (ALNM) in early-stage breast cancer remains unclear. Understanding this association could provide insights for nodal staging in the era of axillary surgery de-escalation, guiding adjuvant treatment decisions. Objectives: To investigate and validate the association between PNI and both the presence and extent of ALNM in patients with early-stage operable invasive breast cancer. Design: A retrospective cohort study and meta-analysis. Methods: We conducted a retrospective study of patients with early-stage operable breast cancer who underwent surgery between June 2011 and June 2023 stratified by PNI status. Three matching methods-propensity score matching, inverse probability of treatment weighting, and overlap weighting-were used to minimize confounding. Multivariable logistic regression analysis was used to assess the association between PNI and both ALNM and lymph node ratio (LNR). In addition, a meta-analysis was conducted to verify these associations. Results: < 0.05). In the meta-analysis, 16 cohort studies comprising 17,451 participants met the selection criteria. The analysis confirmed a significant association between PNI and increased ALNM risk (odds ratio (OR), 3.30; 95% confidence interval (CI), 2.24-4.86), poorer disease-free survival (hazard ratio (HR), 1.84; 95% CI, 1.39-2.44), and poorer overall survival (HR, 1.64; 95% CI, 1.15-2.35). Conclusion: PNI is significantly associated with increased ALNM and lymph node burden in early-stage operable breast cancer. These findings support the clinical utility of PNI for risk stratification and as a potential indicator for guiding adjuvant treatment decisions.

Source: Therapeutic Advances in Medical Oncology