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
Processing time: 281 Days and 11.6 Hours
ARTICLE HIGHLIGHTS
Research background

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

Research motivation

The clinical features, survival, and prognostic factors of Chinese patients with PMME are not comprehensively analyzed until now.

Research objectives

This study aimed to investigate the clinical features, survival, and prognostic factors of Chinese patients with PMME.

Research methods

The clinicopathological findings of ten cases with PMME treated at our hospital and 280 cases from both the English- and Chinese-language literature which focused on Chinese patients with PMME were analyzed.

Research results

Only about half of the patients (55.8%) were accurately diagnosed before surgery. Lymph node metastasis (LNM) was easy to be found with a positive rate of 45.3% even when the tumor was confined in the submucosal layer. The risk of LNM was significantly raised along with the increase of pT stage (P < 0.001) and larger tumor size (P = 0.006). The median overall survival (OS) and disease-free survival (DFS) were 11 mo and 5.3 mo, respectively. Multivariate Cox analysis showed that both pT stage (P = 0.005) and LNM (P = 0.009) were independent prognostic factors for OS, but only advanced pT stage (P = 0.02) was identified to be a significant independent indicator of poor RFS in patients with PMME.

Research conclusions

Correct diagnosis of PMME before surgery is low. Both LNM and pT stage are the independent prognosis factors for OS, but only pT stage was identified to be an independent indicator for DFS of patients with PMME.

Research perspectives

Physicians and endoscopists should develop their awareness of rare diseases of the esophagus, paying particular attention to early lesions. Extended lymph node dissection combined with a radical esophagectomy should be stressed because of multifocality and a high frequency of LNM. Adjuvant treatment, particularly immunotherapy, might be used in clinical practice to improve multidisciplinary treatments and the prognosis of patients with PMME.