Retrospective Analysis Of Different Local Treatment Modes Of Patients With Breast Cancer With Ipsilateral Supraclavicular Lymph Node Metastasis

Research background and Purpose:ISLM with breast cancer patients has always been a hard problem for breast surgery.In treatment,it is generally believed that radiotherapy can benefit the survival of patients,but whether local surgical resection is needed or not is controversial.The purpose of this study was to evaluate the efficacy of supraclavicular lymph node dissection plus radiotherapy and radiotherapy alone of breast cancer with ISLM.The purpose of this study is to provide reference for follow-up treatment by exploring the benefits of different treatment methods of breast cancer with ISLM.Methods:108 patients with breast cancer without distant metastasis with ipsilateral supraclavicular lymph node metastasis were enrolled in the Department of Breast Cancer of Hospital from January 1,2010 to December 31,2019.14 patients were deleted because of incomplete data.The 108 patients were divided into dissection plus radiotherapy group(surgery group)(n=84)and radiotherapy group(n=24)according to whether supraclavicular lymph node dissection was performed.All patients were confirmed by pathology that breast cancer with ISLM.Telephone,Wechat and other ways were used to understand the survival situation of the patients.SPSS24.0 software was used for statistical analysis.χ2 test or Fisher exact probability test was used to analyze the correlation of clinicopathological features between surgery group and radiotherapy group.Kaplan-Meier and Cox methods were used for survival analysis.log-rank test was used for survival curve.The P<0.05 was statistically significant.Results:108 patients,84(77.8%)in the surgery group and 24(22.2%)in the radiotherapy group.59 patients had recurrence and metastasis during the follow-up period,including 41(48.8%)in the surgery group,34(40.5%)with distant metastasis,15(17.9%)with local recurrence,and 8(9.5%)with recurrence and metastasis.18(75%)patients in the radiotherapy group,including 11(45.8%)with distant metastasis,15(62.5%)with local recurrence,and 8(33.3%)with recurrence and metastasis.The local recurrence between the two groups had significant difference(P<0.05).23 patients died,17(20.2%)in the surgery group and 6(25.0%)in the radiotherapy group,There was no difference(P>0.05).The 5-year disease-free survival(DFS)rate was 30.6%and the 5-year overall survival(OS)rate was 67.8%of the 108 patients,respectively.The 5-year DFS of the surgery group and radiotherapy group were 34.3%and 26.1%respectively,and there was no difference(P>0.05).Cox analysis showed that ER status(95%CI:1.337-3.889,P=0.002)and axillary lymph node status(95%CI:1.259～3.627,P=0.005)were the influencing factors of 5-year disease-free survival in patients with ISLM breast cancer.The 5-year OS of the surgery group and the radiotherapy group were 67.9%and 67.5%respectively,and there was no significant difference between the two groups(P>0.05).Cox analysis showed that the status of ER(95%CI:1.100～18.288,P=0.036)was an independent factor affecting the 5-year survival rate.Conclusion:1.Supraclavicular surgery and radiotherapy or radical radiotherapy had no significant effect on the survival of breast cancer patients with ISLM.2.The status of ER and the number of axillary lymph node metastasis were independent influencing factors of the prognosis survival,the status of ER were independent influencing factors of the overall survival.