Clinical characteristics and treatment outcomes of primary malignant melanoma of esophagus: a single center experience
Tóm tắt
Primary malignant melanoma of esophagus (PMME) is an extremely rare disease with poor prognosis. We aimed to determine the clinical characteristics and treatment outcomes of patients with PMME. We retrospectively reviewed 17 patients diagnosed with PMME in Samsung Medical Center between 2000 and 2020 with median 34 months of follow-up. Survival outcomes were analyzed with Kaplan–Meier method. 15 patients (88.2%) were male and the most common presenting symptom was dysphagia (9/17, 52.9%). On endoscopy, tumors were mass-forming in 15 patients (88.2%) and diffusely infiltrative in two patients (11.8%). Lesions were melanotic in 13 patients (76.5%) and amelanotic in four patients (23.5%). The most common tumor location was lower esophagus (11/17, 64.7%). The disease was metastatic at the time of diagnosis in four patients (23.5%). As for treatment, 10 patients (58.8%) underwent surgery. In all 17 patients, the median overall survival was 10 months. In surgically treated patients, all patients experienced recurrence and the median disease-free survival was 4 months. There was no statistical difference in overall survival between patients with or without surgery. Patients with diffusely infiltrative tumor morphology had better overall survival compared to those with mass-forming tumor morphology (P = 0.048). Two patients who received immunotherapy as the first-line treatment without surgery showed overall survival of 34 and 18 months, respectively. As radical resection for patients with PMME does not guarantee favorable treatment outcomes, novel treatment strategy is required. Further large-scale studies are warranted to determine the efficacy of immunotherapy for patients with PMME.
Tài liệu tham khảo
Sabanathan S, Eng J, Pradhan GN. Primary malignant melanoma of the esophagus. Am J Gastroenterol. 1989;84:1475–81.
Ahn JY, Hwang HS, Park YS, Kim HR, Jung HY, Kim JH, et al. Endoscopic and pathologic findings associated with clinical outcomes of melanoma in the upper gastrointestinal tract. Ann Surg Oncol. 2014;21:2532–9.
Weiner JP, Shao M, Schwartz D, Wong A, Schreiber D. Patterns of care and survival outcomes in the treatment of esophageal melanoma. Dis Esophagus. 2017;30:1–6.
Gupta V, Kochhar R, Sinha SK, Das A. Primary malignant melanoma of the esophagus: long-term survival after radical resection. J Thorac Oncol. 2009;4:1180–2.
Hamdy FC, Smith JH, Kennedy A, Thorpe JA. Long survival after excision of a primary malignant melanoma of the oesophagus. Thorax. 1991;46:397–8.
Harada K, Mine S, Yamada K, Shigaki H, Oya S, Baba H, et al. Long-term outcome of esophagectomy for primary malignant melanoma of the esophagus: a single-institute retrospective analysis. Dis Esophagus. 2016;29:314–9.
Wang S, Tachimori Y, Hokamura N, Igaki H, Kishino T, Kushima R. Diagnosis and surgical outcomes for primary malignant melanoma of the esophagus: a single-center experience. Ann Thorac Surg. 2013;96:1002–6.
Shoushtari AN, Wagstaff J, Ascierto PA, Butler MO, Lao CD, Marquez-Rodas I, et al. CheckMate 067: long-term outcomes in patients with mucosal melanoma. J Clin Oncol. 2020;38:10019.
Endo F, Akiyama Y, Onishi M, Fujisawa R, Sasaki N, Nikai H, et al. Primary esophageal malignant melanoma successfully treated with anti-PD-1 antibody for retroperitoneal recurrence after esophagectomy: a case report. Int J Surg Case Rep. 2020;75:152–6.
Ito S, Tachimori Y, Terado Y, Sakon R, Narita K, Goto M. Primary malignant melanoma of the esophagus successfully treated with nivolumab: a case report. J Med Case Rep. 2021;15:237.
Wang X, Kong Y, Chi Z, Sheng X, Cui C, Mao L, et al. Primary malignant melanoma of the esophagus: a retrospective analysis of clinical features, management, and survival of 76 patients. Thorac Cancer. 2019;10:950–6.
Berry MF. Esophageal cancer: staging system and guidelines for staging and treatment. J Thorac Dis. 2014;6(Suppl 3):S289–97.
Kim SH, Lee KS, Shim YM, Kim K, Yang PS, Kim TS. Esophageal resection: indications, techniques, and radiologic assessment. Radiographics. 2001;21:1119–37 (discussion 38–40).
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.
Dai L, Wang ZM, Xue ZQ, He M, Yuan Y, Shang XQ, et al. Results of surgical treatment for primary malignant melanoma of the esophagus: A multicenter retrospective study. J Thorac Cardiovasc Surg. 2020;161:294–302.
Hashimoto T, Makino T, Yamasaki M, Tanaka K, Miyazaki Y, Takahashi T, et al. Clinicopathological characteristics and survival of primary malignant melanoma of the esophagus. Oncol Lett. 2019;18:1872–80.
Cheung MC, Perez EA, Molina MA, Jin X, Gutierrez JC, Franceschi D, et al. Defining the role of surgery for primary gastrointestinal tract melanoma. J Gastrointest Surg. 2008;12:731–8.
Karl RC, Schreiber R, Boulware D, Baker S, Coppola D. Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg. 2000;231:635–43.
Jezerskyte E, Saadeh LM, Hagens ERC, Sprangers MAG, Noteboom L, van Laarhoven HWM, et al. Long-term health-related quality of life after McKeown and Ivor Lewis esophagectomy for esophageal carcinoma. Dis Esophagus. 2020;33:doaa022.
Kranzfelder M, Seidl S, Dobritz M, Brücher BL. Amelanotic esophageal malignant melanoma: case report and short review of the literature. Case Rep Gastroenterol. 2008;2:224–31.
Joob AW, Haines GK 3rd, Kies MS, Shields TW. Primary malignant melanoma of the esophagus. Ann Thorac Surg. 1995;60:217–22.
Kaufman HL, Kirkwood JM, Hodi FS, Agarwala S, Amatruda T, Bines SD, et al. The Society for Immunotherapy of Cancer consensus statement on tumour immunotherapy for the treatment of cutaneous melanoma. Nat Rev Clin Oncol. 2013;10:588–98.
D’Angelo SP, Larkin J, Sosman JA, Lebbé C, Brady B, Neyns B, et al. Efficacy and safety of nivolumab alone or in combination with ipilimumab in patients with mucosal melanoma: a pooled analysis. J Clin Oncol. 2017;35:226–35.
Tyrrell H, Payne M. Combatting mucosal melanoma: recent advances and future perspectives. Melanoma Manag. 2018;5:Mmt11.
Curtin JA, Fridlyand J, Kageshita T, Patel HN, Busam KJ, Kutzner H, et al. Distinct sets of genetic alterations in melanoma. N Engl J Med. 2005;353:2135–47.
Lian B, Cui CL, Zhou L, Song X, Zhang XS, Wu D, et al. The natural history and patterns of metastases from mucosal melanoma: an analysis of 706 prospectively-followed patients. Ann Oncol. 2017;28:868–73.
Lyu J, Wu Y, Li C, Wang R, Song H, Ren G, et al. Mutation scanning of BRAF, NRAS, KIT, and GNAQ/GNA11 in oral mucosal melanoma: a study of 57 cases. J Oral Pathol Med. 2016;45:295–301.
Zebary A, Jangard M, Omholt K, Ragnarsson-Olding B, Hansson J. KIT, NRAS and BRAF mutations in sinonasal mucosal melanoma: a study of 56 cases. Br J Cancer. 2013;109:559–64.
Yang AS, Chapman PB. The history and future of chemotherapy for melanoma. Hematol Oncol Clin North Am. 2009;23(583–97):x.
Apetoh L, Ladoire S, Coukos G, Ghiringhelli F. Combining immunotherapy and anticancer agents: the right path to achieve cancer cure? Ann Oncol. 2015;26:1813–23.