Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1739
Peer-review started: December 2, 2021
First decision: March 11, 2022
Revised: April 24, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: September 15, 2022
Processing time: 281 Days and 11.6 Hours
Primary malignant melanoma of the esophagus (PMME) is a rare malignant disease and has not been well characterized in terms of clinicopathology and survival.
To investigate the clinical features and survival factors in Chinese patients with PMME.
The clinicopathological findings of ten cases with PMME treated at Henan Provincial People’s Hospital were summarized. Moreover, the English- and Chinese-language literature that focused on Chinese patients with PMME from 1980 to September 2021 was reviewed and analyzed. Univariate and multivariate analyses were employed to investigate the clinicopathologic factors that might be associated with survival.
A total of 290 Chinese patients with PMME, including ten from our hospital and 280 from the literature were enrolled in the present study. Only about half of the patients (55.8%) were accurately diagnosed before surgery. Additionally, 91.1% of the patients received esophagectomy, and 88 patients (36.5%) received adjuvant therapy after surgery. The frequency of lymph node metastasis (LNM) was 51.2% (107/209), and LNM had a positive rate of 45.3% even when the tumor was confined to the submucosal layer. The risk of LNM increased significantly with the pT stage [P < 0.001, odds ratio (OR): 2.47, 95% confidence interval (CI): 1.72-3.56] and larger tumor size (P = 0.006, OR: 1.21, 95%CI: 1.05-1.38). The median overall survival (OS) was 11.0 mo (range: 1-204 mo). The multivariate Cox analysis showed both the pT stage [P = 0.005, hazard ratio (HR): 1.70, 95%CI: 1.17-2.47] and LNM (P = 0.009, HR: 1.78, 95%CI: 1.15-2.74) were independent prognostic factors for OS. The median disease-free survival (DFS) was 5.3 mo (range: 0.8-114.1 mo). The multivariate analysis indicated that only the advanced pT stage (P = 0.02, HR: 1.93, 95%CI: 1.09-3.42) was a significant independent indicator of poor RFS in patients with PMME.
The correct diagnosis of PMME before surgery is low, and physicians should pay more attention to avoid a misdiagnosis or missed diagnosis. Extended lymph node dissection should be emphasized in surgery for PMME even though the tumor is confined to the submucosal layer. Both the LNM and pT stage are independent prognosis factors for OS, and the pT stage is the prognosis factor for DFS in patients with PMME.
Core Tip: Primary malignant melanoma of esophagus (PMME) is a rare malignant disease. We comprehensively analyzed the clinicopathological characteristics of 290 Chinese patients with PMME. Only about half of the patients were accurately diagnosed before surgery. The positive rate of lymph node metastasis (LNM) was 45.3% even the tumor confined to the submucosal layer. The median overall survival (OS) and disease-free survival were 11.0 mo and 5.3 mo, respectively. Cox analysis showed that both pT stage and LNM were the independent prognostic factors for OS, while only advanced pTNM stage was a significant independent indicator of poor RFS in patients with PMME.