Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis

Objective: To investigate the clinical efficacy and prognostic factors of breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM) receiving neoadjuvant chemotherapy, surgery combined with radiotherapy at diagnosis. Methods: Therapeutic outcomes of 65 breast cancer patients with ISLNM treated in our hospital between 1999 and 2013 were retrospectively analyzed. All patients were pathologically diagnosed with breast cancer. They were complicated with ISLNM, without distant metastasis confirmed by pathological or imaging examinations. All patients received multi-modality therapy consisting of neoadjuvant chemotherapy, surgery and postoperative radiotherapy. KaplanMeier method was adopted to calculate the overall survival (OS), progression-free survival (PFS) and supraclavicular lymph node recurrence (SCFR). The differences between two groups were statistically analyzed by the log-rank test. Results: The median follow-up time was 66 months (range: 6-137 months). Five patients had SCFR after corresponding treatment. The overall 5- year SCFR, OS and PFS rates were 9.2%, 71.5% and 49.5%, respectively. Following preoperative chemotherapy, the complete response (CR) of supraclavicular lymph node was a prognostic factor affecting OS. The 5- year OS rates in patients with and without CR were 81.4% and 53.9% (P = O.035). The size of supraclavicular lymph node (≤ 1 cm vs. > 1 cm at diagnosis was a risk factor of the SCFR (0% vs. 21.0%, P = 0.037) and OS rates (≤ 1 cm vs. > 1 cm: 86.1% vs. 55.6%, P = 0.001). Conclusions: Breast cancer patients with ISLM at diagnosis can obtain high OS rate and excellent tumor control after undergoing multi-modality therapy consisting of preoperative chemotherapy, surgery and postoperative radiotherapy. (authors)