Comparison Of Different Local Treatment Patterns In Breast Cancer With Ipsilateral Supraclavicular Lymph Node Metastasis

Objective: The purpose of this study was to explore the best local treatment pattern of supraclavicular lymph node in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis(s ISLM),to find the best beneficiaries,and to provide clinical reference for breast cancer patients to make individualized treatment plan.Methods: A total of 128 breast cancer patients with s ISLM were retrospectively analyzed,according to the local treatment pattern of supraclavicular lymph node,68 cases were treated with supraclavicular lymph node dissection combined with radiotherapy,60 cases were treated with radiotherapy alone.The median follow-up time was 68 months(55-122 months).To compare the localregion relapse-free survival(LRFS),distant metastasis-free survival(DMFS),progression-free survival(PFS)and overall survival(OS)of the two group patients,and further explore the influence of different local treatment patterns on the prognosis.Results: On univariate analysis,the 5-year LRFS of combined group and radiotherapy alone group were 79.2% and 88.9%(P=0.140),the 5-year DMFS were 65.8% and 55.9%(P=0.412),the 5-year PFS were 55.8% and 56.0%(P=0.830),the 5-year OS were 64.7% and 65.9%(P=0.472),but there was no significant difference.On multivariate analysis,the expression level of Ki67 was independent prognostic factor for the 5-year LRFS;local treatment pattern of supraclavicular lymph node,whether the supraclavicular lymph node achieved complete remission(CR)after chemotherapy,axillary lymph node metastasis degree(number of positive / number of dissection),histological grade and hormone receptor status were independent prognostic factors for the 5-year DMFS;local treatment pattern of supraclavicular lymph node,whether the supraclavicular lymph node achieved CR after chemotherapy,whether tumor invaded the skin or chest muscle,axillary lymph node metastasis degree,histological grade,endocrine therapy or not were independent prognostic factors for the 5-year PFS;local treatment pattern of supraclavicular lymph node,radiation dose of supraclavicular region,whether the supraclavicular lymph node achieved CR after chemotherapy,clinical tumor size,axillary lymph node metastasis degree,histological grade,endocrine therapy or not were independent prognostic factors for the 5-year OS.On subgroup analysis,when receiving radiotherapy alone,the 5-year LRFS,DMFS,PFS,OS of the supraclavicular region radiation dose > 50 Gy group were all better than the 50 Gy group numerically,but statistical analysis showed that significant difference was only found in the 5-year OS(P=0.047).When receiving supraclavicular lymph node dissection combined with radiotherapy,no significant difference in the 5-year LRFS,DMFS,PFS,OS was found between the supraclavicular region radiation dose > 50 Gy group and the 50 Gy group.When the number of supraclavicular lymph node dissection was less than 10,the 5-year LRFS,DMFS,PFS,OS of the supraclavicular region radiation dose > 50 Gy group were all better than the 50 Gy group numerically,but unfortunately no significant difference was found;when the number of supraclavicular lymph node dissection was more than 10,the 5-year LRFS,DMFS,PFS,OS of the supraclavicular region radiation dose 50 Gy group were all better than the > 50 Gy group numerically,but statistical analysis showed that significant difference was only found in the 5-year DMFS(P=0.028).Conclusions:1.For breast cancer patients with s ISLM,supraclavicular lymph node dissection combined with radiotherapy may improve DMFS,PFS and OS.2.When receiving radiotherapy alone,a radiation boost to the supraclavicular region may improve OS;When receiving supraclavicular lymph node dissection combined with radiotherapy,if the degree of supraclavicular lymph node dissection is low,a radiation boost to the supraclavicular region may benefit.,if the degree of supraclavicular lymph node dissection is high,a radiation boost to the supraclavicular region may not benefit significantly.