Chen Shin-Cheh, Shen Shih-Che, Yu Chi-Chang, Huang Ting-Shuo, Lo Yung-Feng, Chang Hsien-Kun, Lin Yung-Chang, Kuo Wen-Ling, Tsai Hsiu-Pei, Chou Hsu-Huan, Lee Li-Yu, Huang Yi-Ting
Department of General Surgery, Division of Breast Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, Linkou Branch, Taoyuan 333, Taiwan.
Department of General Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan.
Cancers (Basel). 2021 Dec 29;14(1):164. doi: 10.3390/cancers14010164.
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 ( = 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; = 0.002 and HR, 1.76, 95% CI, 1.23-2.52; = 0.002, respectively) and OS (HR, 1.77; 95% CI, 1.22-2.55; = 0.003 and HR, 3.54, 95% CI, 2.44-5.16; < 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.
我们回顾性纳入了1990年至2008年期间在单一医疗中心接受初次手术的8129例连续患者中发生异时性孤立性锁骨上淋巴结转移（miSLNM）的139例患者。中位年龄为47岁。本研究中，从原发性肿瘤手术日期起的中位随访时间为73.1个月，颈部复发日期的中位时间为43.9个月。61例（43.9%）患者接受了选择性颈部清扫术（SND）。SND组的5年无远处转移生存率（DMFS）、复发后生存率和总生存率（OS）分别为31.1%、40.3%和68.9%，而未进行SND组的相应生存率分别为9.7%、32.9%和57.7%（P = 0.001）。在DMFS的多因素分析中，未进行SND以及从原发性肿瘤手术到颈部复发的时间间隔≤24个月是仅有的显著危险因素（风险比（HR）分别为1.77；95%置信区间（CI）为1.23 - 2.56；P = 0.002和HR为1.76，95%CI为1.23 - 2.52；P = 0.002）以及OS（HR分别为1.77；95%CI为1.22 - 2.55；P = 0.003和HR为3.54，95%CI为2.44 - 5.16；P < 0.0001）。包括颈部清扫术在内的多模式治疗显著改善了miSLNM的DMFS和OS。通过强化手术治疗控制miSLNM后的生存改善表明miSLNM并非远处转移。
