Clinicopathological characterization of ten patients with primary malignant melanoma of the esophagus and literature review

Table 1 Clinicopathological features of ten cases of primary malignant melanomas of the esophagus from Henan Provincial People’s Hospital

Case No.	Gender	Age (yr)	Chief complaint	Location	Gross classification	Tumor number	Preoperative diagnosis	Tumor length	Deep in depth	LNM	Treatment	Survival (mo)
1	Male	61	Dysphagia	Middle	NA	1	PMME	NA	NA	NA	NA	FU loss
2	Female	59	Dysphagia	Middle	NA	1	PMME	NA	NA	NA	NA	FU loss
3	Male	47	Dysphagia	Lower	NA	1	PMME	NA	NA	NA	NA	FU loss
4	Female	60	Dysphagia	Lower	NA	1	PMME	NA	NA	NA	NA	FU loss
5	Female	80	Dysphagia	Middle	NA	1	PMME	NA	NA	NA	R + C	31
6	Male	69	Dysphagia	Middle	NA	1	PMME	NA	NA	NA	C	51
7	Male	57	Dysphagia	Upper	Ulcering	1	Poor differentiated carcinoma	5	DP	No	S	18
8	Female	74	Retrosternal pain	Lower	Polypoid	2	PMME	5	SM	No	S	FU loss
9	Male	62	bellyache	Middle	Polypoid	1	PMME	2.5	DP	No	S	3
10	Male	52	Dysphagia and retrosternal pain	Middle	Polypoid	1	PMME	4	SM	No	S	22 alive

PMME: Primary malignant melanoma of esophagus; NA: Not applicable; SM: Submucosal layer; MP: Muscularis propria; FU: Follow up; S: Surgery; C: Chemotherapy; R: Radiotherapy.

Table 2 Clinicopathologic characteristics of 290 primary malignant melanoma of esophagus patients

Characteristic	n	%
Gender
Male	200	69.0
Female	90	31.0
Age	58.4 ± 9.7 yr
Symptoms
Dysphagia	219	79.1
Restrosternal pain	13	4.7
Dysphagia and restrosternal pain	18	6.5
Bellyache	11	4.0
No symptom found by physical examination	8	2.9
Loss of appetite	6	2.2
Hoematemesis or melena	2	0.7
Censored	13
Location
Upper	16	5.4
Middle	137	47.3
Lower	137	47.3
Pigmentation
Yes	141	71.9
No	55	28.1
Censored	94
Pathological diagnosis of biopsy
PMME	115	55.8
ESCC	32	15.5
Poorly differentiated carcinoma	39	18.9
Esophageal adenocarcinoma	10	4.9
High-grade dysplasia or non-neoplastic lesions	10	4.9
Censored	84
Treatment
Surgery	153	58.8
Surgery and adjuvant treatment	88	35.1
Adjuvant treatment	16	6.1
Censored	33
Tumor size (censored: n = 77)	5.2 ± 2.9 cm
Tumor number
Single	74	61.7
Multiple	46	38.3
Censored	170
Gross classification
Superficial elevated	14	5.7
Polypoid	194	77.9
Ulcerative and others	36	14.4
Censored	46
Depth of invasion
T1	97	45.6
T2	67	31.4
T3 and T4	49	23.0
Censored	77
Lymph node metastasis
Yes	107	51.2
No	102	48.8
Censored	81

Table 3 Correlation between lymph node metastasis and clinicopathological features

Feature	LNM-		LNM+		P valve	Logistic regression analysis
	n	%	n	%		P valve	OR (95%CI)
Gender
Male	77	51.0	74	49.0	0.307
Female	25	43.1	33	56.9
Age (yr)	59.4 ± 8.9		57.2 ± 10.3		0.109
Location
Upper	3	75.0	1	25.0	0.202
Middle	52	53.6	45	46.4
Lower	47	43.5	61	56.5
Tumor size (cm)	4.6 ± 2.4		6.0 ± 3.0		< 0.001	0.006	1.21 (1.05-1.38)
Tumor number
Single	23	41.1	33	58.9	0.919
Multiple	14	40.0	21	60.0
Censored	67	54.5	56	46.5
Gross classification
Superficial elevated	11	91.7	1	8.3	0.01	0.261
Polypoid	68	46.6	78	53.4
Ulcerative and others	14	45.2	17	54.8
Censored	9	45	11	55
Infiltration depth
T1a	14	100	0	0	< 0.001	< 0.001	2.22 (1.47-3.33)
T1b	40	54.8	33	45.2
T2	30	48.4	32	51.6
T3 + T4	9	20.0	36	80.0
Censored	9	60	6	40

LNM: Lymph node metastases; OR: Odds ratio; CI: Confidence interval.

Table 4 Univariate and multivariate analyses of predictive factors for overall survival and disease-free survival in patients with primary malignant melanoma of esophagus

Variable	Overall survival				Disease-free survival
	Uni-P	Multi-P	HR	95%CI	Uni-P	Multi-P	HR	95%CI
Gender
Male vs female	0.08				0.450
Age (yr)
< 55 vs ≥ 55	0.348				0.353
Tumor location
Upper vs middle vs lower	0.647				0.385
Tumor number
Single vs multiple	0.200				0.227
Tumor size (cm)
< 5.5 vs ≥ 5	0.282				0.124
Gross classification
Superficial vs polypoid vs ulcerative and others	0.04	0.249			0.007	0.893
Depth of invasion
T1a vs T1b vs T2 and T3 and T4	0.001	0.005	1.70	1.17-2.47	0.02	0.02	1.93	1.09-3.42
LNM
No vs yes	< 0.001	0.009	1.78	1.15-2.74	0.07
pTNM stage
I vs II vs III and IV	< 0.001	0.349			0.02	0.540
Treatment
Surgery vs surgery plus adjuvant therapy	0.433				0.02	0.698

LNM: Lymph node metastases; pTNM: Pathological tumor node metastasis; HR: Hazard ratio; CI: Confidence interval.