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Qigen Fang,1 Fei Liu,2 Dongjie Seng3 1Department of Head and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China; 2Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; 3Department of Ear, Nose, and Throat, Affiliated Children Hospital of Zhengzhou University, Zhengzhou, China Background: The goal of this study was to investigate the long-term oncologic outcome of parotid mucoepidermoid carcinoma (MEC) in pediatric patients. Patients and methods: Patients <19 years old who were diagnosed with MEC from January 1990 to December 2017 were retrospectively enrolled in this study. The main analyzed indexes included intraparotid node (IPN) metastasis, neutrophil-tolymphocyte ratio (NLR), loco-regional control (LRC), and disease-specific survival (DSS) rates. Results: A total of 73 patients were enrolled. IPN metastasis occurred in 13 (17.8%) patients; the mean value of the NLR was 2.48 (range: 1.3–6.1). Loco-regional recurrence occurred in 12 patients, and 7 patients died of the disease. The 10-year LRC and DSS rates were 83% and 88%, respectively. IPN metastasis remained significantly related to recurrence in both univariate and Cox model analyses; a high NLR was significantly associated with recurrence in the univariate analysis but not in the Cox model. IPN metastasis remained significantly related to disease-related death in both the univariate and Cox model analyses; a high NLR was not associated with the DSS in univariate analysis. Conclusion: The long-term survival rate was relatively favorable in pediatric MEC. IPN metastasis was an independent risk factor for loco-regional recurrence and DSS. The role of the NLR in predicting survival in parotid cancer requires more research. Keywords: pediatric cancer, salivary cancer, parotid cancer, mucoepidermoid carcinoma