{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:51:06Z","timestamp":1785419466258,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Objective: Mucoepidermoid carcinoma (MEC) is the most common malignant tumour of the parotid gland. This systematic review and meta-analysis aims to evaluate treatment strategies, survival, recurrence, and prognostic factors in primary parotid MEC. Materials and Methods: A systematic review was conducted following PRISMA guidelines. PubMed\/MEDLINE, the Cochrane Library, Scopus, and Google Scholar were searched to identify eligible observational studies and clinical trials on primary parotid MEC. Pooled estimates of overall survival (OS), disease-specific survival (DSS), and local, regional, and distant recurrence rates were calculated. Prognostic factors associated with survival and recurrence were analysed. Results: Twenty-one studies involving 7192 patients were analysed. Histologic grade was low in 32.2%, intermediate in 41.8%, and high in 26.1%. Surgical treatment included total parotidectomy (2606 patients) and superficial parotidectomy (1642), with facial nerve preservation achieved in 1993 of 4111 reported cases. Positive margins occurred in 18% of patients, and postoperative radiotherapy was administered in 50%. Mean follow-up was 72.6 months. Pooled OS rates were 100% at 1 year, 90% at 5 years, and 70% at 10 years; DSS was 100% at 5 years and 90% at 10 years. Recurrence rates were 10% local, 0% regional, and 10% distant. High-grade histology, advanced T\/N stage, positive surgical margins, and intraparotid lymph node metastasis were associated with poorer outcomes. Conclusions: Parotid MEC generally has favourable short- and intermediate-term outcomes. Based on evidence and institutional experience, we propose a grade-based workflow integrating tumour grade, T\/N status, and adverse pathological features to guide surgical extent, elective neck dissection, and adjuvant radiotherapy. Prospective studies with standardized reporting are needed.<\/jats:p>","DOI":"10.3390\/cancers18071146","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:51:03Z","timestamp":1775130663000},"page":"1146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic Factors and Survival Outcomes in Parotid Gland Mucoepidermoid Carcinoma: A Systematic Review with Meta-Analysis and Workflow Proposal"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3947-8733","authenticated-orcid":false,"given":"Giovanni","family":"Salzano","sequence":"first","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8717-7121","authenticated-orcid":false,"given":"Veronica","family":"Scocca","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7789-145X","authenticated-orcid":false,"given":"Luigi Angelo","family":"Vaira","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0845-0845","authenticated-orcid":false,"given":"Jerome R.","family":"Lechien","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Mons, 7301 Mons, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Scarpa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8421-0328","authenticated-orcid":false,"given":"Stefania","family":"Troise","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6479-6130","authenticated-orcid":false,"given":"Giovanni Dell\u2019Aversana","family":"Orabona","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1177\/000348949009901015","article-title":"Histopathologic Grading of Salivary Gland Neoplasms: I. Mucoepidermoid Carcinomas","volume":"99","author":"Batsakis","year":"1990","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_2","unstructured":"Auclair, P.L. (1991). Surgical Pathology of the Salivary Glands, WB Saunders Co., Ltd."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14740\/wjon1412","article-title":"Advances in the Treatment of Mucoepidermoid Carcinoma","volume":"13","author":"Sama","year":"2022","journal-title":"World J. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1002\/cncr.23825","article-title":"Treatment and survival outcomes based on histologic grading in patients with head and neck mucoepidermoid carcinoma","volume":"113","author":"Nance","year":"2008","journal-title":"Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1007\/s00405-016-4407-5","article-title":"Probability and pattern of occult cervical lymph node metastases in primary parotid carcinoma","volume":"274","author":"Stodulski","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"224","DOI":"10.6004\/jnccn.2022.0016","article-title":"NCCN Guidelines\u00ae Insights: Head and Neck Cancers, Version 1.2022: Featured Updates to the NCCN Guidelines","volume":"20","author":"Caudell","year":"2022","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s10147-023-02416-9","article-title":"Clinicopathological characteristics of four major histological types of high-grade parotid carcinoma","volume":"28","author":"Kawata","year":"2023","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1002\/hed.27486","article-title":"Number of positive lymph nodes is superior to neck stage of the 8th AJCC in predicting prognosis in parotid mucoepidermoid carcinoma","volume":"45","author":"Li","year":"2023","journal-title":"Head Neck"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1002\/hed.27128","article-title":"Presentation and outcomes of patients with clinically T1-2, N0 parotid mucoepidermoid carcinoma: The roles of elective neck dissection and adjuvant radiotherapy","volume":"44","author":"Sullivan","year":"2022","journal-title":"Head Neck"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/lary.30135","article-title":"Influence of Grading on Management and Outcome in Mucoepidermoid Carcinoma of the Parotid\u2014A Multi-institutional Analysis","volume":"133","author":"Grasl","year":"2023","journal-title":"Laryngoscope"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1002\/hed.26735","article-title":"Mucoepidermoid carcinoma of the parotid gland: TWENTY-YEAR experience in treatment and outcomes","volume":"43","author":"Chan","year":"2021","journal-title":"Head Neck"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.2147\/CMAR.S192788","article-title":"Oncologic outcome of parotid mucoepidermoid carcinoma in pediatric patients","volume":"11","author":"Fang","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Niu, X., Fang, Q., and Liu, F. (2019). Role of intraparotid node metastasis in mucoepidermoid carcinoma of the parotid gland. BMC Cancer, 19.","DOI":"10.1186\/s12885-019-5637-x"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.joms.2019.01.031","article-title":"Deep Parotid Lymph Node Metastasis Is Associated With Recurrence in High-Grade Mucoepidermoid Carcinoma of the Parotid Gland","volume":"77","author":"Shang","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e7237","DOI":"10.7717\/peerj.7237","article-title":"Nomogram to predict the prognosis of parotid gland mucoepidermoid carcinoma: A population-based study of 1306 cases","volume":"7","author":"Sun","year":"2019","journal-title":"PeerJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1002\/lary.27192","article-title":"Has the management of pediatric mucoepidermoid carcinoma of the parotid gland changed?","volume":"128","author":"Janz","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/pbc.26217","article-title":"Surgery combined with postoperative125 I seed brachytherapy for the treatment of mucoepidermoid carcinoma of the parotid gland in pediatric patients","volume":"64","author":"Mao","year":"2017","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1002\/lary.24238","article-title":"Mucoepidermoid carcinoma of the parotid gland treated by surgery and postoperative radiation therapy: Clinicopathologic correlates of outcome","volume":"123","author":"Chen","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/hed.23256","article-title":"Histologic grade as prognostic indicator for mucoepidermoid carcinoma: A population-level analysis of 2400 patients","volume":"36","author":"Chen","year":"2014","journal-title":"Head Neck"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.amjoto.2004.06.017","article-title":"Determinants of survival in parotid gland carcinoma: A population-based study","volume":"26","author":"Bhattacharyya","year":"2005","journal-title":"Am. J. Otolaryngol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.otohns.2006.11.045","article-title":"Clinical Presentation, Management, and Outcome of High-Grade Mucoepidermoid Carcinoma of the Parotid Gland","volume":"136","author":"Emerick","year":"2007","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.oraloncology.2006.03.001","article-title":"Mucoepidermoid carcinoma of the salivary glands","volume":"43","author":"Rapidis","year":"2007","journal-title":"Oral Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1001\/archotol.132.4.375","article-title":"Mucoepidermoid Carcinoma of the Parotid Gland in Children: A 10-Year Experience","volume":"132","author":"Rahbar","year":"2006","journal-title":"Arch. Otolaryngol. Neck Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.oraloncology.2004.01.017","article-title":"Mucoepidermoid carcinoma of the salivary glands\u2014Clinical review of 42 cases","volume":"41","author":"Kokemueller","year":"2005","journal-title":"Oral Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1001\/archotol.130.7.849","article-title":"Mucoepidermoid Carcinoma of the Parotid Gland: The Mayo Clinic Experience","volume":"130","author":"Boahene","year":"2004","journal-title":"Arch. Otolaryngol. Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1017\/S0022215100142148","article-title":"Histological features and prognosis of patients with mucoepidermoid carcinoma of the parotid gland","volume":"112","author":"Suzuki","year":"1998","journal-title":"J. Laryngol. Otol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/j.1365-2273.1987.tb00184.x","article-title":"Mucoepidermoid tumour of the parotid gland: A very difficult prognostic evaluation","volume":"12","author":"Laudadio","year":"1987","journal-title":"Clin. Otolaryngol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/S0194-5998(99)70323-2","article-title":"Incidence Rates of Salivary Gland Tumors: Results from a Population-Based Study","volume":"120","author":"Pinkston","year":"1999","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/cas.12039","article-title":"Clinicopathological significance of MAML2 gene split in mucoepidermoid carcinoma","volume":"104","author":"Noda","year":"2013","journal-title":"Cancer Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1097\/PAS.0b013e3181de3021","article-title":"A reappraisal of the MECT1\/MAML2 translocation in salivary mucoepidermoid carcinomas","volume":"34","author":"Seethala","year":"2010","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"69456","DOI":"10.18632\/oncotarget.17282","article-title":"High number of chromosomal copy number aberrations inversely relates to t(11;19)(q21;p13) translocation status in mucoepidermoid carcinoma of the salivary glands","volume":"8","author":"Matse","year":"2017","journal-title":"Oncotarget"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1002\/gcc.20306","article-title":"Molecular classification of mucoepidermoid carcinomas-prognostic significance of the MECT1-MAML2 fusion oncogene","volume":"45","author":"Behboudi","year":"2006","journal-title":"Genes Chromosomes Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3902","DOI":"10.1158\/1078-0432.CCR-05-2376","article-title":"MECT1-MAML2 fusiontranscript defines a favorable subset of mucoepidermoid carcinoma","volume":"12","author":"Okabe","year":"2006","journal-title":"Clin. Cancer Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.oraloncology.2017.02.025","article-title":"Correlation of Crtc1\/3-Maml2 fusion status, grade and survival in mucoepidermoid carcinoma","volume":"68","author":"Birkeland","year":"2017","journal-title":"Oral Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1007\/s00405-021-07039-2","article-title":"Mucoepidermoid carcinoma of the head and neck: CRTC1\/3 MAML 2 translocation and its prognosticators","volume":"279","author":"Bloemena","year":"2022","journal-title":"Eur. Arch. Otorhinolaryngol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1146\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T12:01:34Z","timestamp":1775131294000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["cancers18071146"],"URL":"https:\/\/doi.org\/10.3390\/cancers18071146","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]}}}