The Significance Of Supraclavicular Lymph Node Dissection In Breast Cancer Patients With Supraclavicular Lymph Node Metastasis

ObjectivesTo explore the therapeutic significance of supraclavicular lymph node dissection for breast cancer patients with ipsilateral supraclavicular lymph node metastasis.MethodsThis research retrospects the data of 82 cases of breast cancer patients with ipsilateral supraclavicular lymph node metastasis without distant metastasis admitted to Tangshan People’s Hospital from November 2013 to October 2018.58 cases was treated with neoadjuvant chemotherapy+breast resection+axillary lymph node dissection±(adjuvant chemotherapy/endocrine therapy/targeted therapy)+ipsilateral chest wall radiotherapy+ipsilateral supraclavicular region radiotherapy;24 cases was treated with neoadjuvantchemotherapy+breastresection+axillarylymphnodedissection+supraclavicular lymph node dissection±(adjuvant chemotherapy/endocrine therapy/target therapy)+radiotherapy of ipsilateral chest wall+radiotherapy of ipsilateral supraclavicular region.Overall survival(OS),disease-free survival(DFS),Local control rate(LCR),Distant metastasis rate(DMR),Control rate of ipsilateral supraclavicular lymph nodes(ISCR)and complications are compared between the two groups.According to the size of supraclavicular metastatic lymph nodes,the patients were divided into two subgroups and analyse prognosis of two subgroups.Meanwhile,the prognostic factors of the two groups were analyzed.Results1 Follow-up results:OS,DFS,LCR,DMR and ISCR in surgery+radiotherapy group were not significantly different from those in radiotherapy group(χ~2=1.896,P=0.169;χ~2=0.040,P=0.842;χ~2=0.150,P=0.699;χ~2=0.232,P=0.630;χ~2=0.358,P=0.550).2Subgroup analysis:OS,DFS,LCR,DMR and ISCR in patients with supraclavicular lymph node metastasis whose maximum short diameter was<1cm had no significant difference between the operation+radiotherapy group and the radiotherapy group(χ~2=1.461,P=0.227;χ~2=0.001,P=0.977;χ~2=0.582,P=0.445;χ~2=0.047,P=0.829;χ~2=1.489,P=0.222).In patients with supraclavicular metastatic lymph node shortest diameter≥1cm,there was no significant difference in ISCR between surgery+radiotherapy group and radiotherapy group(χ~2=1.167,P=0.280).3 Prognostic factors:Univariate analysis showed that DFS in patients whose age<53 years was better than those whose age≥53 years,DFS in ER-positive patients was better than that in ER-negative patients,DFS in PR-positive patients was better than that in PR-negative patients,DFS in patients with Ki-67≤30%was better than that in patients with Ki-67>30%,and DFS in patients with Luminal A was significantly better than other types,and the prognosis of patients with three negative types was the worst,(χ~2=8.037,P=0.005;χ~2=7.489,P=0.006;χ~2=5.567,P=0.018;χ~2=5.474,P=0.019;χ~2=14.110,P=0.003).ISCR in patients<53 years old was better than that in patients≥53 years old,ISCR in patients with PR positive was better than that in patients with PR negative,ISCR in patients with Ki-67≤30%was better than that in patients with Ki-67>30%,and ISCR in patients with Luminal A type was significantly better than other types,and the prognosis of patients with triple negative type was the worst(χ~2=6.627,P=0.010;χ~2=6.043,P=0.014;χ~2=5.245,P=0.022;χ~2=11.083,P=0.012).Multivariate analysis showed that age and PR status were independent factors influencing progression-free survival and the local control rate of ipsilateral supraclavicular lymph nodes(χ~2=7.536,P=0.006;χ~2=6.943,P=0.008;χ~2=5.795,P=0.016;χ~2=6.293,P=0.012).4 Complications:There was no significant difference in acute radiation dermatitis,acute radiation pneumonia,brachial plexus nerve injury and I degree radioactive subcutaneous tissue injury between the radiotherapy group and the surgery+radiotherapy group;II degree radioactive subcutaneous tissue injury in the surgery+radiotherapy group was higher than that in the radiotherapy group(χ~2=6.675,P=0.010).Conclusions1 No matter what the size of supraclavicular metastatic lymph nodes,supraclavicular lymph node dissection can not improve the prognosis of patients with ipsilateral supraclavicular lymph node metastasis.2 It is beneficial to the prognosis of patients to define molecular typing and formulate individualized treatment plan.3Subcutaneous tissue injury in operation+radiotherapy group was significantly higher than that in radiotherapy group,which was an important factor affecting the quality of life of patients after neck lymph node dissection.Figure 42;Table 5;Reference 61...