| Objective:ISLM(Ipsilateral Supraclavicular Lymphatic Metastasis)breast cancer has always been a difficult problem to solve for breast surgery.ISLM breast cancer has a small proportion of breast cancer and a low five-year survival rate.The stage of isolated metastasis of breast cancer with ipsilateral supraclavicular lymph node was defined as distant metastasis by AJCC(American Joint Committee on Cancer)and UICC(Union for International Cancer Control)in 1988 and N3 c in 2003.The purpose of this study is to explore the clinical efficacy of comprehensive treatment of ipsilateral supraclavicular lymphatic metastatic breast cancer and provide further inspiration for related clinical research.Methods:A retrospective study was conducted in patients who were diagnosed as breast cancer with ISLM.All patients underwent breast tumor biopsy and supraclavicular lymph node biopsy,which was confirmed by pathology.The patients were divided into three groups:initial operation group,initial chemotherapy group 1 and initial chemotherapy group 2.Initial operation group refers to the patients who firstly underwent surgery,followed by radiotherapy,chemotherapy,endocrine therapy and other treatments.Initial chemotherapy group 1 means to treat patients with neoadjuvant chemotherapy,followed by modified radical mastectomy,postoperative radiotherapy,endocrine therapy and so on.Initial chemotherapy group 2 means to treatpatients with modified radical mastectomy + supraclavicular lymph node dissection for breast cancer,postoperative radiotherapy,endocrine therapy and so on.OS and DFS of initial operation group and initial chemotherapy group were analyzed by Kaplan-Meier method;OS and DFS of initial chemotherapy group 1 and initial chemotherapy group 2were analyzed by Kaplan-Meier method;survival curve was compared by Log-Rank test.Compute P values to compare whether there are significant differences between the data.Results:1.There were 36 patients in the initial operation group,32 patients in the initial chemotherapy group 1 and 36 patients in the initial chemotherapy group 2.The age of patients ranged from 24 to 67 years,including 11 young patients whose age were younger than or equal to 35 years old and 93 patients whose age were older than 35 years old.As far as tumor size was concerned there were 12 cases in T1,40 cases in T2,36 cases in T3 and 16 cases in T4.There were 47 premenopausal patients and 57 menopausal patients.According to the histological classification,46 cases were classified as histological grade II,and 58 cases of grade III histologically.According to the situation of immunohistochemistry,there were 1 case of luminal A type,29 cases of luminal B type,34 cases of HER-2 type and 40 cases of triple negative type.2.The patients were followed up for 5 years,the 5-year DFS of the initial operation group and the initial chemotherapy group were 3% and 4%,respectively.5-year OS(Overall survival)was 53% and 60% respectively in the initial operation group and initial chemotherapy group.There was no significant difference in DFS and OS between the two groups.3.Analysis of disease-free survival curves between the initial chemotherapy group1 and the initial chemotherapy group 2: 5-year DFS was 3% and 6%,respectively.The disease-free survival curves of both groups suggested that patients benefits from supraclavicular lymph node dissection,evaluated by DFS(P=0.025).4.Survival curve analysis of initial chemotherapy group 1 and initial chemotherapy group 2: OS was 56% and 66% respectively in 5 years.There was no significantdifference(P=0.368).Conclusion:1.Supraclavicular lymph node dissection plays an active role in improving disease-free survival of ISLM breast cancer patients.2.Supraclavicular lymph node dissection does not improve the overall survival of ISLM breast cancer patients.3.Initial surgical treatment does not increase disease-free distant survival and the overall survival of ISLM breast cancer patients. |
PDF Full Text Request