title: Outcomes of patients with breast cancer who present with ipsilateral supraclavicular or internal mammary lymph node metastases.
abstract: BACKGROUND
  The prognostic implications of internal mammary (IM) and supraclavicular (SC) node involvement in locally advanced breast cancer is still unclear.
  
  
  METHODS
  We evaluated 107 patients with IM (n = 65) or SC (n = 42) node involvement who underwent operation at the European Institute of Oncology between 1997 and 2009 to assess their prognostic features. We subsequently analyzed matched cohorts, using the 107 patients as cases and another group of patients as a control cohort, to evaluate prognostic differences between patients with and those without IM or SC node involvement.
  
  
  RESULTS
  Five-year disease-free survival (DFS) was 84% in IM vs. 38.8% in SC node involvement (P < .0001), and 5-year overall survival (OS) was 96.9% in IM node vs. 57.1% in SC node involvement (P < .0001). No difference in outcome was found between patients with and controls without IM node involvement. Conversely, a statistically significant difference in DFS and locoregional recurrence was observed in patients with SC node involvement compared with controls without SC node involvement.
  
  
  CONCLUSIONS
  SC node involvement correlated with a significantly poorer outcome in patients with locally advanced breast cancer. Adequate staging, including biopsy of suspicious locoregional ipsilateral lymph nodes, is mandatory in these patients. Patients with IM or SC node involvement should be treated with curative intent using combined-modality treatments.
authors.affiliation: Division of Medical Senology, European Institute of Oncology, Milan, Italy. Electronic address: silvia.dellapasqua@ieo.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Dellapasqua
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bagnardi
authors.affiliation: Division of Medical Senology, European Institute of Oncology, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Balduzzi
authors.affiliation: Division of Medical Senology, European Institute of Oncology, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Iorfida
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotmensz
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Santillo
authors.affiliation: Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viale
authors.affiliation: Division of Medical Senology, European Institute of Oncology, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Ghisini
authors.affiliation: Integrated Breast Surgery Unit, European Institute of Oncology and University of Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
authors.affiliation: Division of Senology, European Institute of Oncology, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Morra
authors.affiliation: Department of Medicine, European Institute of Oncology, Milan, Italy.
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
authors.affiliation: Division of Medical Senology, European Institute of Oncology, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Colleoni
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging
keywords: Breast cancer; Internal mammary chain; Supraclavicular lymph nodes