Influence of Grading on Management and Outcome in Mucoepidermoid Carcinoma of the Parotid-A Multi-institutional Analysis

Stefan Grasl, Stefan Janik, Muhammad Faisal, Matthaeus C Grasl, Johannes Pammer, Ilan Weinreb, Gregor Fischer, John Kim, Ali Hosni, John R de Almeida, David P Goldstein, Boban M Erovic

Research output: Journal article (peer-reviewed)Journal article

5 Citations (Scopus)


OBJECTIVE: To evaluate clinical outcome of low (G1), intermediate (G2), and high-(G3) grade mucoepidermoid carcinomas (MEC) of the parotid gland.

STUDY DESIGN: Retrospective chart review including 212 patients. Clinicopathological data was statistically analyzed regarding grading, overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS).

RESULTS: 105 (49.5%) G1, 73 (34.5%) G2, and 34 (16%) G3 MEC were included and 56 (26.4%) patients presented with neck node metastases. The risk of occult nodal metastases was significantly associated with grading and increased from 9.2% in G1 to 26.7% and 27.8% in G2 and G3 tumors, respectively (p = 0.008). Elective periparotid and cervical lymph node dissection was performed in 170 (80.2%) and 70 (33%) patients, respectively. All patients with positive periparotid nodes when subjected to an additional neck dissection had associated cervical neck node involvement (p < 0.001). Grading was an independent significant prognostic factor for OS (HR 4.05; 95%CI: 1.15-14.35; p = 0.030) and DSS (HR 17.35; 95%CI: 1.10-273.53; p = 0.043). In a subgroup analysis, elective neck dissection (END) was also significantly associated with a better DFS (p = 0.041) in neck node-negative G1 MECs.

CONCLUSION: The risk of occult nodal metastasis in intermediate-grade MEC is as high as in high-grade MEC and that END in G1 tumors is associated with a prolonged DFS. Additionally, periparotid node involvement seems to be a predictor for positive neck node involvement. This study presents some preliminary data to consider END in clinically neck node negative patients with parotid MEC; however, larger series are needed.

LEVEL OF EVIDENCE: 3 Laryngoscope, 2022.

Original languageEnglish
Pages (from-to)124-132
Number of pages9
Issue number1
Early online date27 Apr 2022
Publication statusPublished - Jan 2023


  • Mucoepidermoid carcinoma (MEC)
  • elective neck dissection
  • parotid gland
  • Carcinoma/pathology
  • Humans
  • Carcinoma, Mucoepidermoid/surgery
  • Lymphatic Metastasis
  • Parotid Gland/pathology
  • Retrospective Studies
  • Neoplasm Staging
  • Neck Dissection
  • Parotid Neoplasms/surgery

ASJC Scopus subject areas

  • Otorhinolaryngology


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