[an error occurred while processing this directive] | [an error occurred while processing this directive]
Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis
Li Shuai, Wang Shulian, Song Yongwen, Tang Yu, Jin Jing, Wang Weihu, Liu Yueping, Fang Hui, Ren Hua, Wang Jianyang, Jing Hao, Zhang Jianghu, Rong Qinglin, Qi Shunan, Chen Bo, Lu Ningning, Li Ning, Tang Yuan, Liu Xinfan, Yu Zihao, Li Yexiong
Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 10021,China;
AbstractObjective To investigate the clinical efficacy and prognostic factors of breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM) receiving neoadjuvant chemotherapy, surgery combined with radiotherapy at diagnosis. Methods Therapeutic outcomes of 65 breast cancer patients with ISLNM treated in our hospital between 1999 and 2013 were retrospectively analyzed. All patients were pathologically diagnosed with breast cancer. They were complicated with ISLNM, without distant metastasis confirmed by pathological or imaging examinations. All patients received multi-modality therapy consisting of neoadjuvant chemotherapy, surgery and postoperative radiotherapy. Kaplan-Meier method was adopted to calculate the overall survival (OS),progression-free survival (PFS) and supraclavicular lymph node recurrence (SCFR).The differences between two groups were statistically analyzed by the log-rank test. Results The median follow-up time was 66 months (range:6-137 months).Five patients had SCFR after corresponding treatment. The overall 5-year SCFR,OS and PFS rates were 9.2%,71.5% and 49.5%,respectively. Following preoperative chemotherapy, the complete response (CR) of supraclavicular lymph node was a prognostic factor affecting OS. The 5-year OS rates in patients with and without CR were 81.4% and 53.9%(P=0.035).The size of supraclavicular lymph node (≤1 cm vs. >1 cm at diagnosis was a risk factor of the SCFR (0% vs. 21.0%,P=0.037) and OS rates (≤1 cm vs. >1 cm:86.1% vs. 55.6%,P=0.001). Conclusions Breast cancer patients with ISLM at diagnosis can obtain high OS rate and excellent tumor control after undergoing multi-modality therapy consisting of preoperative chemotherapy,surgery and postoperative radiotherapy.
Fund:National Key Research and Development Planning Project (2016YFC0904600);Capital Clinical Characteristic Applied (Z171100001017116)
Corresponding Authors:
Song Yongwen,Email:song21yongwen@aliyun.com,Tel:010-87788876;Wang Shulian,Email:wangshulian@sohu.com, Tel:010-87788803
Cite this article:
Li Shuai,Wang Shulian,Song Yongwen et al. Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis[J]. Chinese Journal of Radiation Oncology, 2019, 28(1): 17-22.
Li Shuai,Wang Shulian,Song Yongwen et al. Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis[J]. Chinese Journal of Radiation Oncology, 2019, 28(1): 17-22.
[1] Chen SC,Chen MF,Hwang TL,et al. Prediction of supraclavicular lymph node metastasis in breast carcinoma[J].Int J Radiat Oncol Biol Phys,2002,52(3):614-619.DOI:10.1016/S0360-3016(01)02680-3. [2] Brito RA,Valero V,Buzdar AU,et al. Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases:the University of Texas M.D.Anderson Cancer Center experience[J].J Clin Oncol,2001,19(3):628-633.DOI:10.1200/JCO.2001.19.3.628. [3] Chen SC,Chang HK,Lin YC,et al. Prognosis of breast cancer after supraclavicular lymph node metastasis:not a distant metastasis[J].Ann Surg Oncol,2006,13(11):1457-1465.DOI:10.1245/s10434-006-9012-1. [4] Breast Cancer,NCCN Guidelines Version 2.2017[DB/OL][2018-03-10].http://www.nccn.org. [5] Wu SG,Sun JY,Zhou J,et al. The value of radiotherapy in breast cancer patients with isolated ipsilateral supraclavicular lymph node metastasis without distant metastases at diagnosis:a retrospective analysis of Chinese patients[J].Oncol Targ Ther,2014,Feb 15;7:e281-288.DOI:10.2147/OTT.S56596. [6] Fan Y,Xu B,Liao Y,et al. A retrospective study of metachronous and synchronous ipsilateral supraclavicular lymph node metastases in breast cancer patients[J].Breast,2010,19(5):365-369.DOI:10.1016/j.breast.2010.03.022. [7] Grotenhuis BA,Klem TM,Vrijland WW.Treatment outcome in breast cancer patients with ipsilateral supraclavicular lymph node metastasis at time of diagnosis:a review of the literature[J].Eur J Surg Oncol,2013,39(3):207-212.DOI:10.1016/j.ejso.2012.11.002. [8] Olivotto IA,Chua B,Allan SJ,et al. Long-term survival of patients with supraclavicular metastases at diagnosis of breast cancer[J].J Clin Oncol,2003,21(5):851-854.DOI:10.1200/JCO.2003.11.105. [9] Edge SB BD,Compton CC,et al. AJCC cancer staging manual[M].7th ed. New York:Springer,2010. [10] Pergolizzi S,Settineri N,Santacaterina A,et al. Ipsilateral supraclavicular lymph nodes metastases from breast cancer as only site of disseminated disease. Chemotherapy alone vs. induction chemotherapy to radical radiation therapy[J].Ann Oncol,2001,12(8):1091-1095.DOI:10.1023/a:1011624401595. [11] 崔蕾.Ⅲ期乳腺癌锁骨上淋巴结清扫的临床意义[D].河北医科大学,2014. Cui L. Clinical significance of supraclavicular lymph node dissection for stage Ⅲ breast cancer[D].Hebei medical university,2014. [12] Jung J,Kim SS,Ahn SD,et al. Treatment outcome of breast cancer with pathologically proven synchronous ipsilateral supraclavicular lymph node metastases[J].J Breast Cancer,2015,18(2):167-172.DOI:10.4048/jbc.2015.18.2.167. [13] Park HJ,Shin KH,Cho KH,et al. Outcomes of positron emission tomography-staged clinical N3 breast cancer treated with neoadjuvant chemotherapy,surgery,and radiotherapy[J].Int J Radiat Oncol Biol Phys,2011,81(5):e689-695.DOI:10.1016/j.ijrobp.2010.11.061.
2019, Vol. 28 
