# A surgical strategy-based nomogram for primary pulmonary mucoepidermoid carcinoma

## TL;DR

This study creates a predictive tool for lung cancer survival based on surgical approaches and patient factors.

## Contribution

A novel nomogram incorporating surgical variables improves survival prediction for primary pulmonary mucoepidermoid carcinoma.

## Key findings

- Pneumonectomy plus lymph node dissection showed best surgical outcomes for PMEC patients.
- The nomogram demonstrated excellent discrimination (AUC > 0.9) and calibration for survival prediction.
- Only 11.01% of PMEC cases were Stage IV, with a 3-year OS of 18.5%.

## Abstract

Primary pulmonary mucoepidermoid carcinoma (PMEC) is a rare malignancy with no standardized prognostic tools. This study aimed to investigate whether specific surgical approaches significantly impact survival outcomes and to develop an accurate predictive nomogram incorporating surgical variables.

Using the SEER database (2004–2020), we identified 225 PMEC patients. Independent prognostic factors were selected via Cox regression (P < 0.05). A nomogram was developed and validated using time-dependent ROC curves, calibration plots, and decision curve analysis (DCA).

We analyzed 225 PMEC cases, predominantly affecting patients aged 30–69 years with slight male predominance. Most tumors (30–52 mm) were early-stage with favorable prognosis; only 11.01% presented as Stage IV (3-year OS: 18.5%, median survival: 8.5 months). The nomogram (incorporating age, tumor size, N/M stage, surgery, and chemotherapy) demonstrated excellent discrimination (AUC > 0.9) and calibration, with pneumonectomy plus lymph node dissection showing the best surgical outcomes.

Our nomogram provides a clinically useful tool for PMEC prognostication, validating that lymph node dissection during lobectomy significantly improves survival. It may guide individualized surgical decisions for this rare malignancy.