Oropharyngeal mucoepidermoid carcinoma: A systematic review of the literature

Abstract

Importance

There is a lack of evidence-based recommendations for patient work up, counseling, and management for mucoepidermoid carcinoma of the oropharynx (OPMEC).

Objective

We aim to summarize the published data on OPMEC and report the demographics, clinical presentation, histology, treatment strategies, and oncologic outcomes in OPMEC.

Methods

A comprehensive medical librarian-led systematic search was conducted of multiple comprehensive databases according to PRISMA guidelines. We searched for articles published through July 7, 2023, and updated the search on February 27, 2024. This was supplemented by a manual search on PubMed and of the bibliographies of included manuscripts. Review articles, national database studies, abstracts and studies not reporting on primary OPMEC were excluded. Inclusion criteria included human studies, population >18 years, peer-reviewed articles, English language, and reports including data of interest for patients with primary OPMEC. The review was conducted by two independent reviewers (GAC and AEB) and conflicts were resolved by the senior author (KMV). Findings were summarized and descriptive statistics were reported.

Results

Twenty-six publications – 2 case series and 24 case reports - describing 80 patients were included. Patients were predominantly female (30/54, 55.6 %) with a median age of 53 years (range: 19–88). OPMEC was most common in the base of tongue (41/54, 75.9 %) and most patients had an oropharyngeal mass noted on examination. Tumors were frequently T1/2 when reported (27/37, 72.9 %). Histological grade was most commonly intermediate grade (31/80, 38.7 %). There were 34 reports of nodal involvement. 21 cases reported both nodal involvement and grade, 5 of which were low grade, 10 intermediate grade, and 6 high grade primary tumors. The most commonly reported treatment modality was surgery alone (15/29, 51.7 %) or surgery with adjuvant radiotherapy (10/29, 34.4 %). 55.0 % (11/20) had positive margins on final pathology. Follow-up length varied (Range 75–146 months) and the overall survival was 85.0 %, with two unrelated deaths and one death likely attributed to OPMEC. Only one publication including 26 cases of OPMEC reported cancer specific survival outcomes, with 75 % 5-year and 65 % 10-year overall survival, and 86 % 5-year and 86 % 10-year distant metastases-free-survival.

Conclusions

OPMEC most often presents in females in their 50's as a base of tongue mass and has a high potential for nodal metastasis despite low or intermediate grading. Oncologic outcomes appear to be favorable following surgery with or without adjuvant therapy. Further research is needed to develop an evidence-based treatment strategy for patients with OPMEC.