Perineural invasion (PNI) and intraneural invasion (INI) are histopathological features associated with aggressive behaviour and local neural spread in salivary gland malignancies (SGMs). They facilitate tumour extension along nerve pathways.

This study aimed to evaluate their prognostic significance with respect to overall survival (OS) and disease-free survival (DFS).

This retrospective cohort study included 49 patients with histologically confirmed salivary gland malignancies diagnosed between 2007 and 2024.

Clinical data were retrieved from institutional records. Histopathological evaluation was done using H&E-stained slides and IHC procedure was done using S100 marker to document the presence of PNI and INI. Clinicopathological variables were evaluated.

Survival analysis was performed using Kaplan–Meier curves with log-rank tests. Cox proportional hazards regression was used to assess the independent prognostic value of PNI, INI, age, and sex.

PNI was identified in eight patients (16.3 %) and INI in two patients (4 %). Kaplan–Meier analysis revealed significantly poorer OS and DFS in PNI-positive patients ( p < 0.001 for both) and INI-positive patients ( p = 0.050 for OS; p = 0.009 for DFS). In multivariate Cox analysis, PNI showed increased risk of mortality (HR = 2.47, p = 0.275) and recurrence (HR = 3.34, p = 0.074). INI also showed an increased hazard trend. Age was significantly associated with DFS (HR = 1.044, p = 0.016), and male sex was significantly associated with OS (HR = 16.48, p = 0.013).

PNI and INI appear to be important indicators of adverse outcomes in SGMs, showing associations with reduced OS and DFS, with age and sex also influencing outcomes. Routine reporting of neural invasion may aid in risk stratification and clinical management.