title: Prognosis of breast cancer after supraclavicular lymph node metastasis: not a distant metastasis.
abstract: 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.
authors.affiliation: 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
authors.forename: Shin-Cheh
authors.initials: SC
authors.lastname: Chen
authors.forename: Hsien-Kun
authors.initials: HK
authors.lastname: Chang
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Lin
authors.forename: Wai-Man
authors.initials: WM
authors.lastname: Leung
authors.forename: Chien-Sheng
authors.initials: CS
authors.lastname: Tsai
authors.forename: Yun-Chung
authors.initials: YC
authors.lastname: Cheung
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Lai-Chu
authors.initials: LC
authors.lastname: See
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
mesh_terms: 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