Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1739-1757
Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1739
Clinicopathological characterization of ten patients with primary malignant melanoma of the esophagus and literature review
Sheng-Li Zhou, Lian-Qun Zhang, Xue-Ke Zhao, Yue Wu, Qiu-Yu Liu, Bo Li, Jian-Jun Wang, Rui-Jiao Zhao, Xi-Juan Wang, Yi Chen, Li-Dong Wang, Ling-Fei Kong
Sheng-Li Zhou, Qiu-Yu Liu, Rui-Jiao Zhao, Ling-Fei Kong, Department of Pathology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
Lian-Qun Zhang, Yue Wu, Department of Gastroenterology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
Xue-Ke Zhao, Li-Dong Wang, State Key Laboratory of Esophageal Cancer Prevention and Treatment, Henan Key Laboratory for Esophageal Cancer Research, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Bo Li, Department of Radiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
Jian-Jun Wang, Department of Thoracic Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
Xi-Juan Wang, Department of Pediatrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
Yi Chen, Clinical Research Service Center, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan Province, China
Author contributions: Wang LD, Kong LF, and Zhou SL designed and wrote the paper; Li B, Zhang LQ, and Wang JJ performed data collection and interpretation and follow-up; Zhao XK and Wu Y contributed to data analysis; Wang XJ and Chen Y revised the manuscript; Liu QY and Zhao RJ reviewed the pathology results; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Institute Research Ethics Committee of Henan Provincial People’s Hospital.
Informed consent statement: Patients enrolled in this study were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author at lfkong9@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ling-Fei Kong, MD, PhD, Chief Doctor, Professor, Department of Pathology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, No. 7 Weiwu Road, Zhengzhou 450003, Henan Province, China. lfkong9@163.com
Received: December 2, 2021
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
Abstract
BACKGROUND

Primary malignant melanoma of the esophagus (PMME) is a rare malignant disease and has not been well characterized in terms of clinicopathology and survival.

AIM

To investigate the clinical features and survival factors in Chinese patients with PMME.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Primary malignant melanoma of the esophagus, Clinicopathological characteristics, Treatment, Recurrence, Survival

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.