Prognosis of breast cancer after supraclavicular lymph node metastasis: not a distant metastasis.
BACKGROUND
We performed this study to analyze the survival of breast cancer patients with isolated supraclavicular lymph node metastasis (SLNM) and assess whether SLNM is distant metastasis or not.


METHODS
Sixty-three patients who developed an isolated SLNM among 3170 primary breast cancer patients between 1990 and 1999 were enrolled. The survival after SLNM was compared with that of 151 patients who developed local recurrences and 599 who had distant metastasis and was analyzed according to different levels and numbers of positive axillary nodes.


RESULTS
Thirty-five of the 63 patients died during a median follow-up of 58.3 months. The 5-year overall survival (OS) rates after SLNM, local relapse, and distant metastasis were 33.6%, 34.9%, and 9.1%, respectively. The 5-year OS for patients with involved nodes confined to axillary level I was 74.4%, which was significantly better than that for involved nodes in level II or III or SLNM (49.2%, 52.8%, and 33.6%, respectively; P < .0001). For one to three positive axillary nodes, the 5-year OS was 83.2%, which was significantly better than that for four to nine positive nodes, more than nine positive nodes, and SLNM (62.6%, 42.3%, and 33.6%, respectively). There was no significant difference between SLNM and more than nine positive nodes. Surgical removal of the supraclavicular nodes was a significantly better prognostic factor for OS after SLNM (P = .0327).


CONCLUSIONS
The 5-year OS after supraclavicular nodal metastosis, local relapse, and distant metastasis were 33.6%, 34.9%, and 9.1%, respectively. Good neck control either by surgery or chemotherapy achieved better survival.
Chen
Shin-Cheh
SC
Department of Surgery, Chang-Gung Memorial Hospital, Chang Gung University Medical College, 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan. chensc@adm.cgmh.org.tw
Chang
Hsien-Kun
HK
Lin
Yung-Chang
YC
Leung
Wai-Man
WM
Tsai
Chien-Sheng
CS
Cheung
Yun-Chung
YC
Hsueh
Swei
S
See
Lai-Chu
LC
Chen
Miin-Fu
MF
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000556:secondary; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis