Abstract
BackgroundPrimary pulmonary mucoepidermoid carcinoma (PMEC) is an extremely rare malignancy. Its clinical characteristics and prognosis are not fully understood. This study evaluated clinical characteristics and prognostic factors of PMEC and established a nomogram to predict its 1-, 3-, 5- and 10-year cancer-specific survival (CSS) rates.MethodsIn the Surveillance, Epidemiology, and End Results database from January 1, 2016 to December 31, 2016, patients pathologically diagnosed with PMEC were identified. Kaplan–Meier analysis and Cox regression were performed to evaluate the CSS stratified by different covariates. A predictive nomogram model was built and validated by the concordance index (C-index) and calibration curves.ResultsA total of 585 PMEC patients were identified. A total of 408 (70%) of patients were placed into the training cohort, and 177 (30%) patients were placed into the validation cohort. The 5- and 10-year CSS rates of stage I–II PMEC patients were 91.4 and 88.9, respectively. The 1-, 3- and 5-year CSS rates of stage III–IV PMEC were 56.5, 39.45, and 32.1%, respectively. Survival curves showed that older age, large tumor size, poor differentiation, and high TNM stage were associated with a significantly worse prognosis. CSS outcomes were significantly better in patients who received surgical treatments (surgical alone, surgery plus radiation and/or chemotherapy). Patients who received radiation and/or chemotherapy had the worst prognosis. Multivariate Cox results revealed that covariates, including age, tumor laterality, tumor sizes, pathological differentiation, lymph node metastasis, distant metastasis, TNM stage and therapy, were independent prognostic factors for PMEC. These factors were used to construct a nomogram. The C-index of the nomogram was 0.921. The calibration curve presented favorable consistency between the predicted CSS and actual observations. This nomogram was validated by the validation cohort. The C-index of the validation cohort was 0.968.ConclusionAge, bilateral tumors, tumor size, pathological differentiation grade, lymph node metastasis, distant metastasis, TNM stage and therapy were independent prognostic factors of PMEC patients. The first nomogram for predicting the CSS of PMEC was built and validated, showing its potential value in practice.
Highlights
Primary pulmonary mucoepidermoid carcinoma (PMEC) is an extremely rare malignancy
PMEC was more common in younger populations (59.4% of patients were aged less than 60 years versus 40.5% of patients were aged more than 60 years)
Surgical resection was performed in 83.7% of PMEC tumor patients
Summary
Primary pulmonary mucoepidermoid carcinoma (PMEC) is an extremely rare malignancy. This study evaluated clinical characteristics and prognostic factors of PMEC and established a nomogram to predict its 1-, 3-, 5- and 10-year cancer-specific survival (CSS) rates. Lung cancer is the most commonly diagnosed cancer in both males and females globally [1,2,3]. Mucoepidermoid carcinoma (MEC) is a subtype of salivary gland tumors (SGTs), which represent a group of fairly rare lung tumors [4]. It is estimated that MEC accounts for only less than 1% of primary malignant lung neoplasms [5, 6]. Due to its low frequency of pulmonary origination, little is known about the demographics, treatment, survival, or prognostic factors associated with primary pulmonary mucoepidermoid carcinoma (PMEC). There is an opportunity to profile the understanding of PMEC by assessing it in a more targeted series
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