Clinical Significance Of Ipsilateral Supraclavicular Lymph Node Metastasis For Breast Cancer

Purpose: To investigated the high-risk factors and prognostic values of ipsilateral supraclavicular lymph node metastasis(ISLM)in breast cancer patients.Methods: From 2005 to 2015,a total of 96 breast cancer patients were recruited with suspected ISLM by imageology.All patients were treated with modified radical mastectomy combined with ipsilateral supraclavicular lymph node dissection(ISLND)and preoperative neoadjuvant chemotherapy(NACT).According to the postoperative pathological results,the patients were divided into positive and negative group of groups of ipsilateral supraclavicular lymph nodes(ISLN).We investigated the risk factors for ISLM and prognostic values of ISLM in breast cancer patients.Results: Positive ISLNs according ISLND after NACT were found in 50 cases,accounting for 53% of all patients.Univariate analysis showed that ISLM was significantly associated with KI67 > 20%(P=0.023),increased number of involved axillary lymph node(ALN)(P<0.001),subclavian lymph nodes(P<0.001),internal mammary node(IMN)(P=0.009).However,multivariate analysis showed that the only ALN metastasis was an independent indicator for ISLM(OR=10.234,95%CI,1.978-52.946,P=0.006 for 4-9 involved ALN;OR=22.322,95%CI,4.887-101.963,P<0.001 for >9 involved ALN).The DFS and OS for patients with positive ISLNs were significantly lower than that for patients with negative ISLNs(HR=2.823,95%CI,1.512-5.270,P=0.0011 for DFS;HR=3.174,95%CI,1.612-6.253,P=0.0008 for OS).ISLM was a significant prognostic factor for breast cancer patients(HR=3.605,95% CI,1.521-8.547;P=0.004 for DFS;and HR=6.393,95%CI,2.311-17.684;P<0.0001 for OS,respectively).Herceptin was a significant prognostic factor for breast cancer patients(DFS:HR=0.254,95%CI: 0.740-0.875,P=0.003;HR=0.249,95%CI: 0.067-0.929,P=0.038).Positive PR and negative HER-2 were significantly better prognostic factors for OS after NACT(P = 0.027,P =0.009,respectively),and ALN positive number>9 after NACT was significantly worse prognostic factor for the DFS(P = 0.028).Conclusion: The risk of ISLM in ALN positive(4-9 involved ALN and > 9 involved ALN)patients was significantly higher than that in negative or <3 involved ALN patients.ISLND is helpful methods to detect the ISLNs status and prognostic values of ISLM in breast cancer patients.Multimodality treatment is strongly recommended for breast cancer patients with ISLM for better survival.