Chen Yao, He JinLan, Song TianYi, Zhang YuNa, Chen Jie, Wang XiaoDong, Li Yan
Breast Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China.
BMC Cancer. 2024 Dec 23;24(1):1572. doi: 10.1186/s12885-024-13316-0.
This study aimed to assess combined supraclavicular lymph node dissection (SLND) and radiotherapy (RT) versus standalone radiotherapy for efficacy in newly diagnosed breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM).
Totally 143 ISLNM patients treated between 2014 and 2021 in two medical institutions were examined retrospectively. Patients were divided into two groups to undergo combined SLND and radiotherapy (surgery + RT, n = 73) or radiotherapy alone (RT, n = 70). The effects of SLND on disease-free survival (DFS), breast cancer-specific survival (BCSS), and overall survival (OS) were assessed by Kaplan-Meier analysis and Cox regression models.
During a median follow-up of about 35 months, 18.2% of patients died. Five-years OS, BCSS, and DFS rates in the RT and surgery + RT groups were 79.2% and 69.4% (P = 0.21), 82.2% and 79.4% (P = 0.29), and 56.1% and 53.1% (P = 0.70), respectively. In multivariable analysis, SLND didn't significantly impact these outcomes, a finding consistent across multiple subgroups. However, Estrogen receptor expression, the presence of vascular cancer emboli, and surgical approach differentially affected DFS, BCSS, and OS. Furthermore, patients with residual supraclavicular lymph node tumors post-surgery had lower DFS (43.7% vs. 73.2%) and OS (68.7% vs. 90.2%) rates compared with counterparts without residual lymph nodes. Residual supraclavicular lymph node tumor was an independent risk factor for DFS (HR = 4.191, 95%CI 1.755-10.007; p = 0.001) and OS (HR = 3.781, 95%CI 1.025-13.486; p = 0.046) in breast cancer patients with ISLNM.
Breast cancer patients with synchronous ISLNM may not benefit from SLND. The clinical decision-making for ISLNM patients should be carefully considered. Prospective studies are needed to validate the results.
本研究旨在评估锁骨上淋巴结清扫术（SLND）联合放疗（RT）与单纯放疗对新诊断的同侧锁骨上淋巴结转移（ISLNM）乳腺癌患者的疗效。
回顾性分析2014年至2021年在两家医疗机构接受治疗的143例ISLNM患者。患者分为两组，分别接受SLND联合放疗（手术+RT，n = 73）或单纯放疗（RT，n = 70）。通过Kaplan-Meier分析和Cox回归模型评估SLND对无病生存期（DFS）、乳腺癌特异性生存期（BCSS）和总生存期（OS）的影响。
在约35个月的中位随访期内，18.2%的患者死亡。RT组和手术+RT组的5年总生存期、BCSS和DFS率分别为79.2%和69.4%（P = 0.21）、82.2%和79.4%（P = 0.29）、56.1%和53.1%（P = 0.70）。在多变量分析中，SLND对这些结果没有显著影响，这一发现在多个亚组中一致。然而，雌激素受体表达、血管癌栓的存在和手术方式对DFS、BCSS和OS有不同影响。此外，术后锁骨上淋巴结有残留肿瘤的患者与无残留淋巴结的患者相比，DFS率（43.7%对73.2%）和OS率（68.7%对90.2%）较低。残留锁骨上淋巴结肿瘤是ISLNM乳腺癌患者DFS（HR = 4.191，95%CI 1.755 - 10.007；p = 0.001）和OS（HR = 3.781，95%CI 1.025 - 13.486；p = 0.046）的独立危险因素。
同步ISLNM的乳腺癌患者可能无法从SLND中获益。对于ISLNM患者的临床决策应谨慎考虑。需要前瞻性研究来验证结果。
