Abstract

There is a lack of studies exploring whether the survival of patients with distant lymph node metastases (DLNM) is different from that of patients with ipsilateral supraclavicular lymph node metastases (ISLM) and other stage IV breast cancer. To assess the survival of patients with DLNM from breast cancer vs ISLM and other stage IV breast cancer. This cohort study included 2033 patients diagnosed with breast cancer between January 1, 2010, and December 31, 2014, from the Surveillance, Epidemiology and End Results registries database. Three groups of patients were included: (1) patients with ISLM without any distant metastasis, (2) patients with DLNM, and (3) patients with distant metastases (DLNM excluded). Patients younger than 18 years or older than 100 years were excluded. The data were analyzed in February 2020. Surgery for primary tumor, surgery for distant lymph nodes, and radiotherapy. Overall survival (OS) and breast cancer-specific survival (BCSS). Of the 2033 women (mean [SD] age, 62.03 [14.62] years [range, 23.00-99.00 years]; 1510 White participants [74.3%]) with breast cancer included in the study, 346 patients (17.0%) had DLNM, 212 (10.4%) had ISLM, and 1475 (72.6%) had distant metastases (DLNM excluded). The 3-year BCSS rates were 63.24% for ISLM, 64.54% for DLNM, and 41.20% for distant metastases. The 3-year OS rates were 53.46% for ISLM, 62.67% for DLNM, and 38.21% for distant metastases. Compared with patients with ISLM, patients with DLNM showed similar BCSS (hazard ratio [HR], 0.81; 95% CI, 0.52-1.25; P = .34) and OS (HR, 0.73; 95% CI, 0.51-1.05; P = .09), whereas patients with distant metastases showed significantly poorer BCSS (HR, 1.99; 95% CI, 1.43-2.78; P < .001) and OS (HR, 1.79; 95% CI, 1.35-2.38; P < .001). Of the 346 patients with DLNM, primary surgery (HR, 0.21; 95% CI, 0.12-0.39; P < .001) and radiotherapy (HR, 0.46; 95% CI, 0.25-0.87; P = .02) were significantly associated with improved OS. The results of this cohort study suggest that DLNM of breast cancer, with similar survival to N3c disease (indicating metastases to the ipsilateral supraclavicular lymph nodes), might be a regional disease, and reassessment of the role of lymph node metastases in breast cancer may be necessary. Given these findings, aggressive locoregional therapies for this disease are recommended, although future studies are still needed to confirm these results.

Highlights

  • Breast cancer is a common malignant disease worldwide

  • Compared with patients with ipsilateral supraclavicular lymph node metastases (ISLM), patients with distant lymph node metastases (DLNM) showed similar breast cancer–specific survival (BCSS) and Overall survival (OS) (HR, 0.73; 95% CI, 0.51-1.05; P = .09), whereas patients with distant metastases showed significantly poorer BCSS (HR, 1.99; 95% CI, 1.43-2.78; P < .001) and OS (HR, 1.79; 95% CI, 1.35-2.38; P < .001)

  • The results of this cohort study suggest that DLNM of breast cancer, with similar survival to N3c disease, might be a regional disease, and reassessment of the role of lymph node metastases in breast cancer may be necessary

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Summary

Introduction

Breast cancer is a common malignant disease worldwide. The incidence of synchronous distant metastases in patients with newly diagnosed breast cancer is approximately 3% to 8%.1-3 stage IV breast cancer is an incurable disease with a poor prognosis. Stage IV breast cancer is an incurable disease with a poor prognosis. Patients with central nervous system or liver metastases show poorer survival than patients with other metastasis sites, including bone, the lungs, and distant lymph nodes.[4,5] Systemic therapy is the main treatment for stage IV breast cancer to prolong patient survival and palliate the symptoms. With advances in systemic therapies, highly selected stage IV breast cancer (eg, patients with bone or distant lymph node metastases [DLNM]) may be potentially curable, especially for limited metastatic burden and favorable site cases.[6,7,8] Understanding the characteristics of breast cancer metastasis is necessary to select the appropriate patients for precise and aggressive therapy

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