title: Supraclavicular recurrence after early breast cancer: a curable condition?
abstract: The prognosis of ipsilateral supraclavicular lymph node recurrence after early breast cancer appears to be worse than for other loco-regional recurrences, but better than for distant metastases. The purpose of the present study was to investigate the relationship between different types of salvage treatment and primary patient characteristics, treatment response, and survival after supraclavicular recurrence (SR) in a large patient population. From the Danish Breast Cancer Cooperative Group treatment database 1977-2003, 305 patients were identified with SR without distant disease as site of first recurrence. Salvage treatment types as well as other factors were related to response and survival. The median follow-up time for progression after SR was 25 months. Complete remission was 76% among patients receiving excision surgery, 67% with combined loco-regional and systemic therapy, and 48% with systemic therapy alone. Median progression-free survival (PFS) and overall survival was 18 and 29 months, respectively. The 5-year PFS probability was 15%. In univariate analysis, combination salvage therapy, negative nodal status and low malignancy grade were related to longer PFS. In multivariate analysis, salvage therapy and malignancy grade remained independent factors for survival. In conclusion, the prognosis of SR is generally poor. However, it appears to be a curable condition. An independent marker of improved outcome is local and systemic combination salvage treatment, which can be considered.
authors.affiliation: Department of Oncology, Rigshospitalet, Copenhagen, Denmark. anders.navrsted.pedersen@rh.regionh.dk
authors.forename: Anders N
authors.initials: AN
authors.lastname: Pedersen
authors.forename: Susanne
authors.initials: S
authors.lastname: Møller
authors.forename: Karina D
authors.initials: KD
authors.lastname: Steffensen
authors.forename: Vera
authors.initials: V
authors.lastname: Haahr
authors.forename: Merete
authors.initials: M
authors.lastname: Jensen
authors.forename: Mette M
authors.initials: MM
authors.lastname: Kempel
authors.forename: Søren L
authors.initials: SL
authors.lastname: Jepsen
authors.forename: Ebbe L
authors.initials: EL
authors.lastname: Madsen
authors.forename: Anne
authors.initials: A
authors.lastname: Roslind
authors.forename: Erik
authors.initials: E
authors.lastname: Sandberg
authors.forename: Claudia
authors.initials: C
authors.lastname: Schöllkopf
authors.forename: Peter G
authors.initials: PG
authors.lastname: Sørensen
authors.forename: Karen Margrethe
authors.initials: KM
authors.lastname: Windfeldt
authors.forename: Michael
authors.initials: M
authors.lastname: Andersson
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D003718:Denmark; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome