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食管原发性恶性黑色素瘤食管切除术的长期预后:单机构回顾性分析

Long-term outcome of esophagectomy for primary malignant melanoma of the esophagus: a single-institute retrospective analysis.

作者信息

Harada K, Mine S, Yamada K, Shigaki H, Oya S, Baba H, Watanabe M

机构信息

Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan.

Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.

出版信息

Dis Esophagus. 2016 May;29(4):314-9. doi: 10.1111/dote.12331. Epub 2015 Feb 24.

Abstract

Primary malignant melanoma of the esophagus (PMME) is a highly malignant tumor with a poor prognosis. Because PMME is an extremely rare disease, therapeutic strategies against the tumor have yet to be established, and the efficacy of esophagectomy remains unclear. The objective of this study was to evaluate the post-esophagectomy survival of PMME patients. Ten patients who underwent esophagectomy for PMME between March 2005 and April 2013 at the Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan, were identified from the institutional database. We retrospectively retrieved clinical information and data on the long-term outcomes from the patients' records. Survival rates after esophagectomy were calculated by the Kaplan-Meier method, and the hazard ratios of mortality were determined using the Cox's model. A follow-up study of the 10 patients revealed 7 cancer recurrences and 5 deaths. Median survival time was 34.5 months, and 5 of 10 patients survived longer than 2 years. The 1-year disease-free survival rate was 40%, and the 1- and 3-year overall survival rates were 70% and 60%, respectively. Importantly, all three of the non-relapsing patients were histologically confirmed as free of lymph node involvement. The four patients with lymph node metastasis relapsed within 1 year. The disease-free survival was significantly shorter in patients with lymph node involvement than in those without lymph node involvement (univariate hazard ratio = 13.3, 95% confidence interval 1.85-266.4; P = 0.009). In conclusion, esophagectomy might benefit PMME patients with no lymph node metastasis. Further large-scale cohort studies are needed to establish the treatment strategy for PMME.

摘要

原发性食管恶性黑色素瘤(PMME)是一种预后较差的高恶性肿瘤。由于PMME是一种极其罕见的疾病,针对该肿瘤的治疗策略尚未确立,食管切除术的疗效仍不明确。本研究的目的是评估PMME患者食管切除术后的生存率。从日本东京癌症研究所医院胃肠外科的机构数据库中,识别出2005年3月至2013年4月期间因PMME接受食管切除术的10例患者。我们回顾性地从患者记录中获取了临床信息和长期结局数据。食管切除术后的生存率采用Kaplan-Meier法计算,死亡率的风险比采用Cox模型确定。对这10例患者的随访研究显示有7例癌症复发和5例死亡。中位生存时间为34.5个月,10例患者中有5例存活超过2年。1年无病生存率为40%,1年和3年总生存率分别为70%和60%。重要的是,所有3例未复发患者经组织学证实无淋巴结受累。4例有淋巴结转移的患者在1年内复发。有淋巴结受累的患者无病生存期明显短于无淋巴结受累的患者(单变量风险比=13.3,95%置信区间1.85-266.4;P=0.009)。总之,食管切除术可能使无淋巴结转移的PMME患者受益。需要进一步开展大规模队列研究以确立PMME的治疗策略。

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