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Prognostic factors in head and neck mucoepidermoid carcinoma
Fábio Ramôa Pires1, Oslei Paes de Almeida, Vera Cavalcanti de Araújo
1Section of Oral Pathology, Department of Oral Diagnosis, School of Dentistry of Piracicaba, State University of Campinas, Piracicaba, Brazil.
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.