Survival For Mucoepidermoid Carcinoma Research Articles

Mucoepidermoid Carcinoma of the Salivary Gland: Long Term Outcomes from a Tertiary Cancer Center in India.

To analyze the patterns of failure and factors affecting recurrence and overall survival in mucoepidermoid carcinoma of the salivary gland. The hospital records were retrospectively analyzed from October 2010 to January 2016. Patients diagnosed as mucoepidermoid carcinoma of the salivary gland were eligible for analysis. All patients received surgery as the primary treatment modality with or without post operative radiotherapy. Statistical analysis for factors affecting recurrence was done by cox regression analysis and p value less than 0.05 was considered significant. A total of 116 patients were diagnosed to have malignant salivary gland tumors of which 69 were mucoepidermoid carcinomas (69.5%). The median age was 43years (8-75years). Majority of the tumors occurred in major salivary glands gland (77%). 51% patients were females. Most common stage was stage II (36%) followed by stage I (27.5%), stage IV (20.3%) and stage III (16%). High grade carcinomas comprised 34.8%, intermediate grade 30.4% and low grade 34.8%. 36 patients (52.2%) received adjuvant radiotherapy (60Gy in 30 fractions). At a median follow up of 42months (8-70months), 8 (11.6%) patients died (7 cancer related and 1 noncancer related). The locoregional recurrence rate was 4.3% whereas the distant metastasis rate was 11.6%. Most common site of distant metastasis was lung. The mean disease free survival time was 61.4months and the mean overall survival was 62months. On univariate analysis, age < 50years, node positive, presence of PNI, high grade, presence of LVI and local recurrence were significant factors for distant metastasis (p < 0.05). On multivariate analysis, high grade, presence of LVI and local recurrence were significant factors for distant metastasis (p < 0.05). Mucoepidermoid carcinomas of salivary gland have good long term local control and overall survival. Majority of the recurrences are distant metastasis. High grade, LVI and local recurrence are significant risk factors for distant relapse.

The role of elective neck dissection in high-grade parotid malignancy: A hospital-based cohort study.

The role of elective neck dissection (END) in patients with clinically N0 (cN0), high-grade parotid carcinoma is unclear. The objective of this study was to assess the association between END and survival in patients with cN0, high-grade parotid carcinoma. Retrospective, multicenter cohort study. A review of hospital-based cases from the National Cancer Data Base was performed. Participants included patients diagnosed with cN0, high-grade parotid cancer between January 1, 2004 and December 31, 2013. The primary exposure was receipt of neck dissection. Secondary exposures included receipt of adjuvant radiation and/or chemotherapy. Univariate and multivariate survival analyses were performed. Unadjusted and adjusted survival estimates were determined. Overall, 1,547 patients were included, with a median follow-up time of 48 months. END did not have a statistically significant effect on 3-year survival (3-year: 69.9%, 95% confidence interval [CI]: 67.2 to 72.6). Survival at 3-years among those not receiving END was 66.1% (95% CI: 62.7 to 69.5). Parotidectomy and adjuvant radiotherapy had the strongest effect on mortality. There was no difference in 3-year survival among patients who underwent parotidectomy and adjuvant radiation stratified by receipt of END nor did END have a statistically significant effect on survival in mucoepidermoid carcinoma, adenocarcinoma, high-risk histology, high T stage, or academic center treatment subgroups. END did not have a statistically significant effect on survival among cN0 patients with high-grade parotid cancer when taking into account receipt of adjuvant therapy and confounding. The role of END on survival and locoregional control remains to be further elucidated in prospective studies. 4 Laryngoscope, 130:1487-1495, 2020.

Correlation of Crtc1/3-Maml2 fusion status, grade and survival in mucoepidermoid carcinoma

ObjectiveMucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands. Tumor stage and grade have historically been important predictors of survival. An oncogenic CRTC1- or CRTC3-MAML2 gene fusion has been identified in a number of MECs. Historically, these gene fusions have been associated with lower grade tumors and better survival. However, reported gene fusion rates and prognosis varies widely across studies, and have not controlled for tumor grade. We sought to identify gene fusion rates and outcomes in our cohort of MEC patients. Materials and methodsAn IRB-approved retrospective cohort of patients with MEC was identified at the University of Michigan. Clinical, histologic, and outcome data was collected from medical records. RNA was isolated from formalin fixed paraffin-embedded tumor sections, and qRT-PCR was performed to identify CRTC1/3-MAML2 gene fusions. Sanger sequencing of qRT-PCR products was used to confirm gene fusions. ResultsOverall, 90 patient MEC tumors were collected (58 low-grade, 25 intermediate-grade, and 7 high-grade). Gene fusions were identified in 59% (53/90) of tumors. On univariate and bivariate analysis, fusion status did not significantly associate with grade or survival. ConclusionWe have identified a high rate of CRTC1/3-MAML2 gene fusions in a large cohort of MEC. We do not identify any correlation between fusion status with tumor grade or survival. These findings suggest further characterization of MECs is needed before considering the CRTC1/3-MAML2 gene fusion as a prognostic biomarker. Additional genetic drivers may account for survival and grade in MECs.

Primary malignant pulmonary tumors in children: a review of the national cancer data base

BackgroundThe purpose is to delineate the clinical and pathological characteristics of rare primary malignant pulmonary tumors in children. MethodsUtilizing the National Cancer Data Base (NCDB), we analyzed all children (≤18years) with a primary malignant pulmonary tumor from 1998 to 2011 to identify factors associated with better survival. ResultsOf 211 children identified, the most common histology was carcinoid tumor (n=133, 63%) followed by mucoepidermoid carcinoma (MEC) (n=37, 18%), squamous cell carcinoma (SCC) (n=19, 9%), adenocarcinoma (n=16, 8%), bronchoalveolar carcinoma (BAC) (n=4, 2%), and small cell carcinoma (SCLC) (n=2, <1%). Factors that significantly affected survival include histology, race, tumor size, lymph node status, and extent of surgery. Patients with MEC and carcinoid tumors had a better overall survival compared to patients with other histologies (p<0.0001). The 5-year overall survival for MEC and carcinoid tumors was 100% and 95% (95% CI 87–98), respectively, versus 50% (95%CI 1–91) for BAC, 28% (95%CI 9–52) for SCC, and 26% (95%CI 5–55) for adenocarcinoma. ConclusionThe majority of pediatric patients with a primary malignant pulmonary tumor present with carcinoid tumor or MEC and have an excellent prognosis. Lung cancers which are common in adults, but rare in children, have a worse prognosis.

An Update on Salivary Gland Pathology

Over the past few decades, salivary gland tumor pathology has evolved. This includes recognition of newly defined entities as well as reclassification of other salivary gland tumors [1]. The development of genetic tests have shown that some salivary gland tumors have genetic abnormalities which are specific to a histologic type such as MECT1–MAML2 gene fusion in mucoepidermoid carcinoma and PLAG1 or HMGA2 gene translocation in pleomorphic adenoma. Immunohistochemical studies have aided in both the diagnosis and prognosis of salivary gland tumors. High Ki67 is correlated with poor overall survival in mucoepidermoid carcinoma, acinic cell carcinoma and adenoid cystic carcinoma. High MUC1 in mucoepidermoid carcinoma is associated with higher grade and high recurrence while MUC4 is associated with a lower grade tumor and longer disease free survival. The finding of androgen receptors in salivary duct carcinoma has led to new therapies as these tumors are shown to be responsive to androgen deprivation therapy. Newly described salivary gland entities in the past 20 years include both benign (sclerosing polycystic adenosis, sialolipoma) and malignant (cribriform adenocarcinoma of the tongue, mammary analogue secretory carcinoma) tumors [2]. Newly recognized histologic variants of well-known salivary gland tumors have been reported, to include salivary-duct carcinoma, acinic cell carcinoma and epi-myoepithelial carcinoma [1, 2]. In view of these dramatic changes, the Head and Neck Pathology journal leadership are particularly pleased to bring together an international panel of experts in salivary gland pathology as contributors to this special issue. Guest editors, Michal Michal, M.D, Ph.D and Alena Skalova, M.D, Ph.D have developed a special issue on salivary gland pathology that encompasses the advances in classification, genetics and other emerging concepts in the field. This update on salivary gland pathology is divided into four groups: tumors associated with molecular genetics; high grade and low grade salivary gland carcinomas; histologic variants of benign and malignant salivary gland tumors; and non-neoplastic lesions. Dr. Michal and colleagues first reported on cribriform adenocarcinoma of the tongue in 1999 and since then other pathologists have recognized this rare entity not only in the tongue but also in other minor salivary gland locations. Dr. Michal describes the characterization of this tumor including immunohistochemical and molecular studies. Dr. Goran discusses the salivary gland neoplasms that have fusion oncogenes and the clinical impact of these findings. Dr. Weinreb focuses on hylanizing clear cell carcinoma and in particular the EWSR1-ATF1 fusion set within a discussion of the differential diagnosis. Dr. Skalova rounds out the section on molecular-defined tumors with the features of mammary analogue secretory carcinoma, originally described by Dr. Skalova in 2010. Dr. Nagao discusses high grade transformation and dedifferentiation in both adenoid cystic carcinoma and acinic cell carcinoma. Newly recognized histologic variants of the high grade salivary duct carcinoma such as mucin-rich variant and sarcomatoid variant are described by Dr. Simpson. In contrast to this high grade salivary gland malignancy, Dr. Perez-Ordonez discusses low-grade salivary duct carcinoma and other intraductal carcinomas. Dr. DiPalma provides a review of carcinoma ex pleomorphic adenoma with special emphasis on the evolution of this neoplasm with distinction of the in situ category from minimally invasive and frankly invasive tumors. Recent studies have broadened the histologic range of epithelial-myoepithelial carcinoma and Dr. Seethala describes some of the new variants of this tumor. Dr. Gnepp reviews unusual mucinous tumors of salivary glands and Dr. Agaimy focuses on fat-containing salivary gland neoplasms. Dr. Petersson discusses a rare salivary gland entity: sclerosing polycystic adenosis, first characterized in 1996. We hope these stimulating discussions on common and rare salivary gland lesions will provide our readership with new tools to enable improved diagnosis.

Clinicopathologic Review of Mucoepidermoid Carcinoma

Objective: 1) Describe the epidemiology of mucoepidermoid carcinoma (MEC) in the head and neck treated at a tertiary care hospital. 2) Determine clinical and pathologic predictors of recurrence and survival in patients with mucoepidermoid carcinoma in the head and neck treated at a tertiary care hospital. Method: Medical records of 94 patients (mean age, 50.4 years; M:F, 48:46) who underwent surgical treatment for MEC of the head and neck between 1995 and 2010 were reviewed. Main outcome measures were DFS, DSS, and OS. Clinicopathologic parameters evaluated were age, sex, TNM stage, subsite, adjuvant therapy, tumor grade, and margin status. Results: Of the 94 patients, 42 parotid, 26 palate, 12 oral, 9 submandibular/sublingual, 4 orbital, and 1 parapharyngeal tumors were identified. All patients underwent surgical resection, 32 patients had postoperative radiation and 3 postoperative chemoradiation. The 5-year OS and DSS were 79% and 90% with a median follow-up of 72 months and 45 months, respectively. The 5-year DFS was 74% with 12 patients developing recurrence. On univariate analysis, age &gt;50 ( P = .01), male sex ( P = .008), positive nodal status ( P = .01) and high-grade histology ( P = .003) were predictive of poor prognosis. On multivariate analysis, high-grade histology ( P = .02) and male sex ( P = .04) were predictive of poor prognosis. Conclusion: The epidemiology of MEC is consistent with previous studies. High grade histology continues to be the strongest independent predictor of survival in MEC followed by male sex. Further studies into the molecular biology of MEC that may account for such clinicopathologic features are warranted.