Prognostic factors in head and neck mucoepidermoid carcinoma

OBJECTIVE: To analyze clinical, histological, and immunohistochemical prognostic factors in a large series of patients with mucoepidermoid carcinoma (MEC) treated in a single institution, using univariate and multivariate survival analyses. DESIGN: Inception cohort. SETTING: Referral center. PATIENTS: All patients diagnosed with head and neck MEC from a single cancer referral center from January 19, 1957, to July 12, 1997. MAIN OUTCOME MEASURES: Rates of local recurrence, regional and distant metastasis, and overall actuarial survival. RESULTS: Men represented 53.8% of the cohort, and the parotid gland and palate were affected by MEC in 35.2% and 23.7%, respectively. TNM stage I or II lesions comprised 50.3% of the tumors, and low-grade tumors comprised 45.2%, and the 5-year overall survival was 70.2%. Univariate survival analysis revealed that age older than 40 years (P<.001), male sex (P=.005), fixed tumors (P=.002), invasion of adjacent structures (P=.004), T stage (P<.001), N stage (P<.001), clinical stage (P<.001), histological grade (P<.001), and expression of proliferating cell nuclear antigen (P<.001), Ki-67 (P<.001), and p53 (P<.001) correlated with a poor prognosis. Expression of carcinoembryonic antigen (P=.01) and bcl-2 (P<.001) correlated with a better prognosis. CONCLUSION: Age older than 40 years, fixed tumors, T and N stage, and histological grade are independent significant prognostic factors in patients with MEC.