【medical-news】原发性食管恶性黑色素瘤的诊断和手术治疗
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Diagnosis and Surgical Outcomes for Primary Malignant Melanoma ofthe Esophagus:A Single-CenterExperience
BACKGROUND:
Wesummarize the experience of diagnosis and surgical therapyfor primary malignant melanoma ofthe esophagus (PMME).
METHODS:
Clinicaldata of 13 patients diagnosed as having PMME treated by surgery as their primary therapy from 2000 to 2012 were retrospectivelyanalyzed, and survival information was collected through follow-up.
RESULTS:
Theaverage age (± standard deviation) of participants in this study was 66.4 ± 7.6years, and 84.6% were male. Overall, 61.5% of tumors were located in the lowerthoracic esophagus.The accuracies of clinical T stage, N stage, and TNM stage were 53.9%, 46.2%,and 38.5%, respectively, compared with pathological staging (kappa =0.252, p = 0.023). Surgical mortalityand morbidity were 7.7% and 53.9%, respectively. The incidence of lymph nodemetastasis for patients with tumor invading within the mucosa was 0, butincreased to 42.9% (3 of 7) with tumor invading to the submucosal layer. Primary malignant melanoma of the esophagus in the mid third of the thoracic esophagus had a greater chance to metastasize toperigastric lymph nodes (2 of 5) than to middle mediastinal lymph nodes (1 of5). For PMME located at the lower third of the thoracicesophagus,upper mediastinal lymph node metastasis was more likely to occur (2 of 4) withtumor invasion penetrating the proper muscle layer. Recurrence occurred within1 year in all patients with tumor later than Stage Ib. The most commonrecurrent organ was the liver. The overall 1-year and 5-year postoperativesurvival rates were 54.0% and 35.9%, respectively, and lymph node metastasiswas the independent predictive factor for postoperative survival (p =0.013; odds ratio, 15.05).
CONCLUSIONS:
Despitethe similarity in lymph node metastatic patterns to squamous cell carcinoma,PMME is more inclined to distant metastasis. Clinical staging was inconsistentwith pathological staging for PMME based on endoscopy and computed tomography. Surgical therapy was the optimal treatment forPMME at an earlier stage. Early diagnosis andaggressive lymph node dissection were beneficial for accurate staging,potentially reducing recurrence and thus improving survival.
BACKGROUND:
Wesummarize the experience of diagnosis and surgical therapyfor primary malignant melanoma ofthe esophagus (PMME).
METHODS:
Clinicaldata of 13 patients diagnosed as having PMME treated by surgery as their primary therapy from 2000 to 2012 were retrospectivelyanalyzed, and survival information was collected through follow-up.
RESULTS:
Theaverage age (± standard deviation) of participants in this study was 66.4 ± 7.6years, and 84.6% were male. Overall, 61.5% of tumors were located in the lowerthoracic esophagus.The accuracies of clinical T stage, N stage, and TNM stage were 53.9%, 46.2%,and 38.5%, respectively, compared with pathological staging (kappa =0.252, p = 0.023). Surgical mortalityand morbidity were 7.7% and 53.9%, respectively. The incidence of lymph nodemetastasis for patients with tumor invading within the mucosa was 0, butincreased to 42.9% (3 of 7) with tumor invading to the submucosal layer. Primary malignant melanoma of the esophagus in the mid third of the thoracic esophagus had a greater chance to metastasize toperigastric lymph nodes (2 of 5) than to middle mediastinal lymph nodes (1 of5). For PMME located at the lower third of the thoracicesophagus,upper mediastinal lymph node metastasis was more likely to occur (2 of 4) withtumor invasion penetrating the proper muscle layer. Recurrence occurred within1 year in all patients with tumor later than Stage Ib. The most commonrecurrent organ was the liver. The overall 1-year and 5-year postoperativesurvival rates were 54.0% and 35.9%, respectively, and lymph node metastasiswas the independent predictive factor for postoperative survival (p =0.013; odds ratio, 15.05).
CONCLUSIONS:
Despitethe similarity in lymph node metastatic patterns to squamous cell carcinoma,PMME is more inclined to distant metastasis. Clinical staging was inconsistentwith pathological staging for PMME based on endoscopy and computed tomography. Surgical therapy was the optimal treatment forPMME at an earlier stage. Early diagnosis andaggressive lymph node dissection were beneficial for accurate staging,potentially reducing recurrence and thus improving survival.
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