[The Role of Supraclavicular lymph node dissection in Breast Cancer Patients with Synchronous Ipsilateral Supraclavicular Lymph Node Metastasis]

Combined Therapy Can Improve the Outcomes of Breast Cancer with Isolated Supraclavicular Lymph Node Involvement

Purpose

This study aimed to evaluate the efficacy of systemic combined with local therapies in isolated metachronous ipsilateral supraclavicular lymph node metastasis (mISLM) breast cancer patients.

Patients and Methods

We reviewed the data of mISLM patients admitted by Breast Disease Center of the Affiliated Hospital of Qingdao University, from January 2009 to July 2019. Ninety-nine patients were included and were divided into two groups: the systemic group, which referred to patients who received only systemic therapy, and the combined group, which referred to patients who received systemic therapy plus local therapy (including neck radiotherapy (RT) and/or supraclavicular lymph node dissection surgery). In the combined group, patients were further divided into systemic therapy plus: 1) neck RT, 2) supraclavicular lymph node dissection surgery, and 3) neck RT and supraclavicular lymph node dissection surgery.

Results

The median duration of follow-up was 36 months. The median PFS was 15 months, and the median OS was 35 months. Local control rates of 1 year, 2 years and 3 years were 92.9%, 86.9% and 84.8%, respectively. The combined group (n=56) had a significantly better PFS (P<0.001) and OS (P=0.001) than the systemic group (n=43). Compared with Group B (n=13) and Group C (n=14), Group A (n=29) had a significantly better PFS (P=0.007). Higher dose and conventional dose showed no significant differences regarding the local control rate (P=1.000), PFS (P=0.787) or OS (P=0.690) in the patients who received RT. In multivariate analysis, pN3 stage and combined therapy (systemic therapy plus local therapy) for mISLM affected PFS (P<0.001 and P=0.002, respectively). Neck RT was an independent parameter affecting OS (P=0.002).

Conclusion

In breast cancer patients with mISLM, systemic therapy combined with local therapy could improve PFS and OS. Based on systemic therapy, RT had a better effect on survival than surgery. However, more aggressive methods, such as systemic therapy combined with both RT and surgery or a higher dose of RT, may not be associated with improved PFS or OS in these patients.

Supraclavicular lymph node dissection with radiotherapy versus radiotherapy alone for operable breast cancer with synchronous ipsilateral supraclavicular lymph node metastases: a real-world cohort study

Background

The role of supraclavicular lymph node dissection (SCLD) in the treatment of breast cancer with ipsilateral supraclavicular lymph node metastasis (ISLM) remains controversial. We evaluated the role of SCLD in the treatment of breast cancer with ISLM and identified patients who may benefit from SCLD.

Methods

Data on patients presenting with breast cancer to the Breast Disease Center, Southwest Hospital, The Army Medical University from January 2004 and December 2017 were retrospectively screened. The median duration of follow-up was 36 months (2-175 months). 305 patients who were recently diagnosed with ISLM were eligible for the analysis.

Results

Overall, 9,236 women presented with breast cancer during the study period. Among the patients included, 146 and 159 received SCLD with radiotherapy (RT) and RT alone, respectively. Synchronous ISLM without distant metastases were present in 3.6% cases. The 3- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 79.5% and 73.9%, respectively, and 67.5% and 54.8%, respectively. However, SCLD with RT was not associated with superior survival on both univariate and multivariate analyses. On stratified analyses, patients with non-luminal A tumors with 4-9 positive axillary lymph nodes who underwent SCLD with RT had both superior OS (HR =5.296; 95% CI: 1.857-15.107; P=0.001) and DFS (HR =5.331; 95% CI: 2.348-12.108; P<0.001) compared with those who received RT alone.

Conclusions

SCLD may not beneficial in improving survival for unselected breast cancer patients with ISLNM. There is less of a tendency to perform SCLD in the luminal A group.

Predictive factors and prognostic value of pathologic complete response of ipsilateral supraclavicular lymph nodes in breast cancer after neoadjuvant chemotherapy

Background

Breast cancer with ipsilateral supraclavicular lymph node metastasis is one of the indicators of poor prognosis. Patients who attain pathologic complete response in breast and axillary sites have improved survival and are highest in aggressive HR-HER2- and HER2-positive tumor subtypes. However, there is no study on the related factors and prognostic value of supraclavicular pathologic complete response in breast cancer after neoadjuvant chemotherapy. The aim of our work was to investigate the factors and prognostic significance of pathologic complete response of ipsilateral supraclavicular lymph node metastasis in breast cancer after neoadjuvant chemotherapy.

Methods

A total of 214 patients with breast cancer who had primary ISLN metastasis, receiving NAC and subsequent ISLN dissection, were retrospectively and consecutively reviewed. Univariate and multivariate analyses were performed using χ² test and the logistic regression model, and the prognosis was analyzed by Kaplan-Meier curve.

Results

All patients included were women who were 26-74 years old. The rate of supraclavicular pathologic complete response (pCR) was 53.7%. Multivariate analysis showed that the expression of Ki67, breast pCR, and axillary pCR were independent predictors of supraclavicular pCR (P<0.05). After a median follow-up of 16.2 months, the risk of recurrence and metastasis in patients with supraclavicular pCR was half reduced compared to that of the non-pCR group (HR 0.51, 95% CI, 0.32-0.80, P<0.01), mainly manifested in HR-HER2- and HER2-positive disease.

Conclusions

The expression level of Ki67, breast pCR, and axillary pCR were independent predictors of supraclavicular pCR. Supraclavicular pCR was an independent predictor of disease-free survival (DFS). Surgical removal of supraclavicular lymph nodes can accurately evaluate the rate of supraclavicular pCR, which is of great significance for patient prognosis.