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Here, we have used two large patient cohorts with MECs comprising 551 tumors to study clinical, histological, and molecular predictors of survival. One cohort (n\u2009=\u2009167), with known\n                    <jats:italic>CRCT1\/3-MAML2<\/jats:italic>\n                    fusion status, was derived from the Hamburg Reference Centre (HRC; graded with the AFIP and Brandwein systems) and the other (n\u2009=\u2009384) was derived from the population-based Cancer Registry of North Rhine-Westphalia (LKR-NRW; graded with the AFIP system). The reliability of both the AFIP and Brandwein grading systems was excellent (n\u2009=\u2009155). The weighted kappa for inter-rater agreement was 0.81 (95% CI 0.65\u20130.97) and 0.83 (95% CI 0.71\u20130.96) for the AFIP and Brandwein systems, respectively. The 5-year relative survival was 79.7% (95% CI 73.2\u201386.2%). Although the Brandwein system resulted in a higher rate of G3-MECs, survival in G3-tumors (AFIP or Brandwein grading) was markedly worse than in G1\/G2-tumors. Survival in\u2009&gt;\u2009T2 tumors was markedly worse than in those with lower T-stage. Also, fusion-negative MECs had a worse 5-year progression-free survival. The frequency of fusion-positive MECs in the HRC cohort was 78.4%, of which the majority (86.7%) was G1\/G2-tumors. In conclusion, the AFIP and Brandwein systems are useful in estimating prognosis and to guide therapy for G3-MECs. However, their significance regarding young age (\u2264\u200930\u00a0years) and location-dependent heterogeneity of in particular G2-tumors is more questionable. We conclude that\n                    <jats:italic>CRTC1\/3-MAML2<\/jats:italic>\n                    testing is a useful adjunct to histologic scoring of MECs and for pinpointing tumors with poor prognosis with higher precision, thus avoiding overtreatment.\n                  <\/jats:p>","DOI":"10.1007\/s00428-021-03146-x","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T19:05:52Z","timestamp":1625598352000},"page":"975-985","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Mucoepidermoid carcinoma of the salivary glands revisited with special reference to histologic grading and CRTC1\/3-MAML2 genotyping"],"prefix":"10.1007","volume":"479","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-1392","authenticated-orcid":false,"given":"Andr\u00e9","family":"Fehr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Werenicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Trocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5511-9146","authenticated-orcid":false,"given":"Markus","family":"Falk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7747-9636","authenticated-orcid":false,"given":"Reinhard E.","family":"Friedrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Stammler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6363-9061","authenticated-orcid":false,"given":"Andreas","family":"Stang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5840-8274","authenticated-orcid":false,"given":"Florian","family":"Oesterling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Khil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1017-7363","authenticated-orcid":false,"given":"G\u00f6ran","family":"Stenman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"B\u00f6cker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Tiemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6447-8255","authenticated-orcid":false,"given":"Thomas","family":"L\u00f6ning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,7]]},"reference":[{"key":"3146_CR1","doi-asserted-by":"publisher","unstructured":"Locati LD, Collini P, Imbimbo M, Barisella M, Testi A, Licitra LF, Loning T, Tiemann K, Quattrone P, Bimbatti E, Chiaravalli S, Casanova M, Tamborini E, Carta R, Gasparini P, Guzzo M, Massimino M, Ferrari A (2017) Immunohistochemical and molecular profile of salivary gland cancer in children. 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