Department of Medical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Science, Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang, Beijing, China.
Breast. 2010 Oct;19(5):365-9. doi: 10.1016/j.breast.2010.03.022. Epub 2010 Apr 18.
Clinically, ipsilateral supraclavicular lymph node metastasis (ISLM) in breast cancer can be classified into 2 manifestations: metachronous and synchronous. Synchronous ISLM (T1-4, N3, M0) is stage IIIc. Metachronous ISLM is isolated supraclavicular lymph node relapse after curative treatment. Although both are featured with ipsilateral supraclavicular lymph node metastases they are two clinical entities needing to be addressed differently. It is of particular interest to know other potential discrepancies between them except for the timing of ISLM occurrence. We retrospectively reviewed 2486 breast cancer patients. Among them, 48 women were identified with metachronous ISLM and 33 with synchronous ISLM. No significant difference was found between them in terms of clinicopathological characteristics as well as survival. However, the multivariate analysis showed they had different independent prognostic factors. Axillary lymph node metastasis status (P = 0.009) and chemotherapy after occurrence of ISLM (P = 0.016) were independent prognostic predictors for metachronous ISLM whilst primary tumor size (P = 0.016) and radiotherapy after diagnosis of ISLM (P = 0.022) were independent prognostic factors for synchronous ISLM. The multidisciplinary management of ISLM patients is strongly recommended.
临床上，乳腺癌同侧锁骨上淋巴结转移（ISLM）可分为 2 种表现：同时性和异时性。同时性 ISLM（T1-4、N3、M0）为 IIIc 期。异时性 ISLM 是在根治性治疗后孤立的锁骨上淋巴结复发。虽然两者均有同侧锁骨上淋巴结转移，但它们是两种需要不同处理的临床实体。除了 ISLM 发生的时间外，了解它们之间其他潜在差异尤其重要。我们回顾性分析了 2486 例乳腺癌患者。其中，48 例患者为异时性 ISLM，33 例为同时性 ISLM。两组患者在临床病理特征和生存方面无显著差异。然而，多因素分析显示，它们具有不同的独立预后因素。腋窝淋巴结转移状态（P=0.009）和 ISLM 发生后化疗（P=0.016）是异时性 ISLM 的独立预后预测因素，而原发肿瘤大小（P=0.016）和 ISLM 诊断后放疗（P=0.022）是同时性 ISLM 的独立预后因素。强烈建议对 ISLM 患者进行多学科管理。
