Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

Shin-Cheh Chen,Yung-Chang Lin,Wen-Ling Kuo,Li-Yu Lee,Yi-Ting Huang,Hsu-Huan Chou,Chi-Chang Yu,Yung-Feng Lo,Ting-Shuo Huang,Hsien-Kun Chang,Shih-Che Shen,Hsiu-Pei Tsai

doi:10.3390/cancers14010164

Abstract

Simple SummaryVery limited studies so far have analyzed the long-term oncologic outcomes of breast cancer patients that developed metachronous isolated supraclavicular nodal metastasis (miSLNM) with no available treatment strategy for the critical issue. The study enrolled 139 miSLNM patients; 61 patients underwent selective neck dissection. In median follow-up of 73.1 months, significantly better 5-year overall survival rate was found in the neck dissection group compared to the no-dissection group (68.9% vs. 57.7%, respectively; HR, 1.77 (1.22–2.55), p = 0.003). The findings suggest surgery for miSLNM should be integrated into multimodal therapy of miSLNM, and the restaging of miSLNM as rN3c rather than M1 disease if detected earlier.We retrospectively enrolled 139 patients who developed metachronous isolated supraclavicular lymph node metastasis (miSLNM) from 8129 consecutive patients who underwent primary surgery between 1990 and 2008 at a single medical center. The median age was 47 years. The median follow-up time from date of primary tumor surgery was 73.1 months, and the median time to the date of neck relapse was 43.9 months in this study. Sixty-one (43.9%) patients underwent selective neck dissection (SND). The 5-year distant metastasis-free survival (DMFS), post-recurrence survival, and overall survival (OS) rates in the SND group were 31.1%, 40.3%, and 68.9%, respectively, whereas those of the no-SND group were 9.7%, 32.9%, and 57.7%, respectively (p = 0.001). No SND and time interval from primary tumor surgery to neck relapse ≤24 months were the only significant risk factors in the multivariate analysis of DMFS (hazard ratio (HR), 1.77; 95% confidence interval (CI), 1.23–2.56; p = 0.002 and HR, 1.76, 95% CI, 1.23–2.52; p = 0.002, respectively) and OS (HR, 1.77; 95% CI, 1.22–2.55; p = 0.003 and HR, 3.54, 95% CI, 2.44–5.16; p < 0.0001, respectively). Multimodal therapy, including neck dissection, significantly improved the DMFS and OS of miSLNM. Survival improvement after miSLNM control by intensive surgical treatment suggests that miSLNM is not distant metastasis.

Highlights

Supraclavicular lymph node metastasis (SLNM) of breast cancer is a clinical challenge for most patients presenting with de novo M1 disease, and it has poor outcomes, its incidence rate was 3.7% to 8% [1,2,3,4], more prevalent in patients with high disease burden, such as more than four positive axillary nodes, and those with axillary level II or III nodal involvement
Retrospective chart reviews revealed that metachronous isolated supraclavicular lymph node metastasis (miSLNM) recurrence was detected by self-examination in 6 patients, routine physical examinations in 71 patients, ultrasonography in 44 patients, and computed tomography in
Our data demonstrated that in multimodal therapy, selective neck dissection (SND) in addition to systemic therapy was associated with overall survival improvement when compared with no surgery, and the results are consistent with recent studies showing that long-term survival outcomes of patients with sSLNM were improved by multimodal therapy with curative intent [22,23]

Summary

Introduction

Supraclavicular lymph node metastasis (SLNM) of breast cancer is a clinical challenge for most patients presenting with de novo M1 disease, and it has poor outcomes, its incidence rate was 3.7% to 8% [1,2,3,4], more prevalent in patients with high disease burden, such as more than four positive axillary nodes, and those with axillary level II or III nodal involvement. A recent clinicopathological study demonstrated the association of lymphovascular invasion with regional lymph node metastasis and systemic metastasis, suggesting that the anastomotic pathway of systemic metastasis from primary breast cancer was through regional lymph nodes [5]. Another single hospital database analysis revealed that regional nodal involvement usually precedes systemic metastatic dissemination [6]. Improvement of the survival of patients with SLNM should depend on early detection with intensive clinical surveillance and the aggressive multimodal approach of systemic therapy and radiotherapy [7]. There are limited studies on surgical extirpation, instead of radiotherapy, incorporated in the multimodal therapy of SLNM [8,9,10,11]

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