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10.1245/s10434-006-9012-1
Annals of Surgical Oncology 13:1457-1465 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Prognosis of Breast Cancer After Supraclavicular Lymph Node Metastasis: Not a Distant Metastasis

Shin-Cheh Chen, MD1, Hsien-Kun Chang, MD2, Yung-Chang Lin, MD2, Wai-Man Leung, MD3, Chien-Sheng Tsai, MD3, Yun-Chung Cheung, MD4, Swei Hsueh, MD5, Lai-Chu See, PhD6 and Miin-Fu Chen, MD, FACS1

1 Department of Surgery, Chang-Gung Memorial Hospital, Chang Gung University Medical College, 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan
2 Department of Medical Oncology, Chang-Gung Memorial Hospital, 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan
3 Department of Radiation Oncology, Chang-Gung Memorial Hospital, 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan
4 Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan
5 Department of Pathology, Chang-Gung Memorial Hospital, 5, Fu-Shing Street, Kwei-Shan, Taoyuan, Taiwan
6 Department of Public Health, Statistic Center, Chang Gung University Medical College, Taoyuan, Taiwan

Correspondence: Address correspondence and reprint requests to: Shin-Cheh Chen, MD; E-mail: chensc{at}adm.cgmh.org.tw.

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.

Key Words: Breast cancer • Supraclavicular lymph node metastasis • Prognosis • Metastasis • Neck dissection






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