Results of surgical treatment for primary malignant melanoma of the esophagus: A multicenter retrospective study.

OBJECTIVE: Few large-sample research data sets exist on long-term survival and prognostic factors among patients with primary malignant melanoma of the esophagus (PMME), a rare malignancy associated with poor outcomes. We sought to investigate postoperative survival and prognostic factors in patients with PMME. METHODS: We retrospectively analyzed long-term follow-up results for patients with PMME who underwent surgery at 10 Chinese centers between January 1998 and January 2018. We performed uni- and multivariate analyses to investigate clinicopathologic factors associated with survival. RESULTS: Median overall survival for the entire group (N = 70 patients) was 13.5 months. Female sex (hazard ratio [HR], 0.352; 95% confidence interval [CI], 0.138-0.900; P = .029), ≥12 lymph nodes dissected (HR, 0.274; 95% CI, 0.133-0.563; P < .001), absence of lymph node metastasis (HR, 0.195; 95% CI, 0.084-0.451; P < .001), and postoperative adjuvant therapy (HR, 0.474; 95% CI, 0.249-0.901; P = .023) were factors of favorable prognosis. Preoperative pathologic diagnosis of PMME was as low as 47.1%. A high proportion of patients had lymph node metastasis, including those with early-stage tumors. Rates of lymph node metastasis were 54.2% (13/24) for pT1, 44.4% (12/27) for pT2, 57.1% (8/14) for pT3, and 100% (5/5) for pT4. Regional lymph node recurrence (N = 43 [61.4%]) was the predominant postoperative pattern of recurrence or metastasis. CONCLUSIONS: Female sex, pN0, increased number of lymph nodes dissected, and postoperative adjuvant therapy were associated with better outcomes among patients with PMME. Preoperative pathologic diagnosis of PMME was low, patients had lymph node metastasis (even those with early-stage tumors), and regional lymph node recurrence was common.

[Prognostic analysis of curative surgery for stage IIIA-N2 non-small cell lung cancer].

OBJECTIVE: To investigate the survival and prognostic factors in patients undergoing potentially curative resection of stage IIIA-N2 non-small cell lung cancer. METHODS: Clinical data of eighty-nine patients, who underwent curative operation from January 2003 to April 2007 in the Peking University First Hospital and were pathologically diagnosed as stage IIIA-N2 NSCLC, were reviewed. The patients were followed up until death or the cut-off date. The overall 3-year and 5-year survival rates were calculated, and Cox proportional hazard model was used to determine the clinical and pathological risk factors and evaluate their influence on the survival. RESULTS: The three-year and five-year survival rates were 51.7% and 31.5%, respectively. The univariate Cox regression analysis revealed five significant factors associated with prognosis: the arm of age < 55, T3 stage, lymphovascular invasion (LVI), multiple positive N2 station and the number of positive N2 nodes > 3 were found to be at increased risk of tumor-related death, and those risk factors were confirmed especially in the age ≥ 55 group. Multivariate Cox regression analysis indicated three independent prognostic factors: T3 stage, LVI and multiple positive N2 station. CONCLUSIONS: The results of this preliminary study show that T3 stage, lymphovascular invasion and N2 level (single or multiple station) are associated with the prognosis of stage IIIA-N2 NSCLC patients after potentially curative resection, and the characteristics of age < 55 and the number of positive N2 nodes > 3 may imply worse prognosis.

[Analysis of recurrence patterns after curative resection of stage IIIA-N2 non-small cell lung cancer].

OBJECTIVE: To explore the postoperative recurrence patterns in the patients undergoing potentially curative resection of stage IIIA-N2 non-small cell lung cancer (NSCLC). METHODS: A total of 63 patients underwent curative operation from September 2004 to December 2008 at Peking University First Hospital and were pathologically diagnosed as stage IIIA-N2 NSCLC. Their clinical data were retrospectively reviewed. The follow-ups were conducted to detect the recurrent lesions. The recurrence rates at Year 2-3 were calculated by the Kaplan-Meier method while the Cox proportional hazard model was used to assess the risk factors associated with recurrence. RESULTS: The 2 and 3-year recurrence rate was 46.6% and 57.3% respectively. Only one patient experienced local failure. However, the predominant recurrence pattern was distant failure (27/28). As demonstrated by the univariate Cox regression analysis, 4 significant factors associated with recurrence and the arm of lymphatic or vascular invasion (LVI), number of positive N2 station > 1, number of positive node > 3 and involvement of subcarinal lymph nodes were found to increase the risks of failure (P < 0.05). CONCLUSION: Distant failure is the predominant pattern of postoperative recurrence in the patients of stage IIIA-N2 NSCLC. In addition to LVI, the level of positive N2 station, the number of positive N2 node and the involvement of subcarinal lymph nodes are associated with the postoperative risk of recurrence.