title: Lymphoepithelial carcinoma of the major salivary glands: Predictors of survival in a non-endemic region.
abstract: BACKGROUND
  Lymphoepithelial carcinoma (LEC) of the salivary glands is extremely rare worldwide, with studies limited to small case reports and case series from endemic areas (Southern China, Arctic Inuits) and strong association to Epstein Barr Virus (EBV). Studies on non-endemic regions are even more limited given the reality of only sporadic cases in these areas. Using the National Cancer Database (NCDB), we present the largest study on salivary LEC from a non-endemic region, the United States.
  
  
  METHODS
  A retrospective review of the NCDB from 1998-2012 for LEC of the major salivary glands was performed. Demographic and clinical variables were extracted for analysis. Multivariate COX regression was used to assess predictors of survival.
  
  
  RESULTS
  Two hundred and thirty-eight cases were identified (0.66% of all salivary cancers). Median age at diagnosis was 62 with peak incidence in ages 50-70. Most patients were Caucasian (81.2%), without gender preference. Regional metastasis was common (45.1%) and did not significantly impact survival. Distant metastasis was rare (2%). Overall survival (OS) at 5- and 10 years was 77% and 56%. Surgery and radiotherapy significantly showed better survival outcomes than surgery alone (p<0.001). Age >62, advanced stage, and dual modality therapy were significant predictors of survival in multivariate analysis.
  
  
  CONCLUSIONS
  Lymphoepithelial carcinoma in the US mostly affects an older, Caucasian demographic. Regional metastasis is common and survival is fair at 5- and 10 years. Surgery and radiation are recommended for early and advanced disease stages. Age, stage, and therapy are significant predictors of survival outcomes.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Kevin Y
authors.initials: KY
authors.lastname: Zhan
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Nicolli
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Sobia F
authors.initials: SF
authors.lastname: Khaja
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, United States. Electronic address: headneck@musc.edu.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Day
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012468:Salivary Gland Neoplasms / Q000453:epidemiology*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Carcinoma ex lymphoepithelial lesion; Lymphoepithelial carcinoma; Lymphoepithelial-like carcinoma; Malignant lymphoepithelial lesion; Parotid cancer; Salivary gland cancer; Undifferentiated carcinoma with lymphoid stroma