Prognostic Factors in Esophageal Melanoma: A Systematic Review and Analysis

Background Primary malignant melanoma of the esophagus (PMME) is a rare and aggressive malignancy, comprising less than 0.8% of all esophageal cancers. Due to its rarity, its pathogenesis, clinical presentation, and optimal treatment strategies remain poorly understood. This study aims to evaluate prognostic factors influencing survival outcomes in PMME by analyzing clinical presentation, histopathological features, and treatment approaches, including surgical resection, adjuvant therapies, and immunotherapy. Methods A systematic review and retrospective analysis were conducted using data from 130 studies comprising 187 PMME patients. Kaplan–Meier survival curves, Cox proportional hazards regression, and logistic regression analysis were employed to assess survival outcomes and predictive factors. Results Overall survival (OS) rates were 66.8% at 1 year, 29.9% at 2 years, and 7.5% at 5 years, while disease-free survival (DFS) rates were 67.9%, 20.3%, and 6.9%, respectively. Patients with nodal metastasis had significantly lower survival rates than those without (p = 0.02). Kaplan–Meier survival analysis indicated that tumor invasion depth (p < 0.001), surgical approach (p = 0.03), and extent of lymphadenectomy (p = 0.02) significantly impacted OS. Additionally, DFS was notably affected by tumor morphology (p = 0.04) and multifocality (p = 0.02). Multivariate Cox regression identified tumor depth (p = 0.04) as independent predictors of poor survival. Conclusion Tumor invasion depth and size remain the strongest prognostic indicators in PMME. While surgical resection is the primary treatment modality, further studies are needed to explore the effectiveness of immunotherapy and targeted therapies in improving survival outcomes.