Skip to main content
Top
Published in: Annals of Surgical Oncology 11/2006

01-11-2006

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

Authors: Shin-Cheh Chen, MD, Hsien-Kun Chang, MD, Yung-Chang Lin, MD, Wai-Man Leung, MD, Chien-Sheng Tsai, MD, Yun-Chung Cheung, MD, Swei Hsueh, MD, Lai-Chu See, PhD, Miin-Fu Chen, MD, FACS

Published in: Annals of Surgical Oncology | Issue 11/2006

Login to get access

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.
Literature
1.
go back to reference Fentiman IS, Lavelle MA, Caplan D, et al. The significance of supraclavicular recurrence of breast cancer. Cancer 1986;57:908–10CrossRefPubMed Fentiman IS, Lavelle MA, Caplan D, et al. The significance of supraclavicular recurrence of breast cancer. Cancer 1986;57:908–10CrossRefPubMed
2.
go back to reference Halverson KJ, Perez CA, Kuske RR, et al. Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 1992;23:285–91PubMed Halverson KJ, Perez CA, Kuske RR, et al. Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 1992;23:285–91PubMed
3.
go back to reference Debois JM. The significance of a supraclavicular node metastasis in patients with breast cancer. Strahlenther Onkol 1997;173:1–12PubMedCrossRef Debois JM. The significance of a supraclavicular node metastasis in patients with breast cancer. Strahlenther Onkol 1997;173:1–12PubMedCrossRef
4.
go back to reference Mc Kinna F, Gothard L, Ashley S, et al. Lymphatic relapse in women with early breast cancer: a difficult management problem. Eur J Cancer 1999;35:1065–9CrossRef Mc Kinna F, Gothard L, Ashley S, et al. Lymphatic relapse in women with early breast cancer: a difficult management problem. Eur J Cancer 1999;35:1065–9CrossRef
5.
go back to reference Fodor J, Tóth J, Major T, et al. Incidence and time of occurrence of regional recurrence in stage I-II breast cancer: value of adjuvant irradiation. Int J Radiat Oncol Biol Phys 1999;44:281–7CrossRefPubMed Fodor J, Tóth J, Major T, et al. Incidence and time of occurrence of regional recurrence in stage I-II breast cancer: value of adjuvant irradiation. Int J Radiat Oncol Biol Phys 1999;44:281–7CrossRefPubMed
6.
go back to reference Kiricuta IC, Willner J, Kölbl O, et al. The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. Int J Radiat Oncol Biol Phys 1993;28:387–93 Kiricuta IC, Willner J, Kölbl O, et al. The prognostic significance of the supraclavicular lymph node metastases in breast cancer patients. Int J Radiat Oncol Biol Phys 1993;28:387–93
7.
go back to reference Signletary SE, Allred C, Ashley P, et al. Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 2002;20:3628–36CrossRef Signletary SE, Allred C, Ashley P, et al. Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 2002;20:3628–36CrossRef
8.
go back to reference Chen SC, Chen MF, Hwang TL, et al. Prediction of supraclavicular lymph node metastasis in breast carcinoma. Int J Radiat Oncol Biol Phys 2002;52:614–9CrossRefPubMed Chen SC, Chen MF, Hwang TL, et al. Prediction of supraclavicular lymph node metastasis in breast carcinoma. Int J Radiat Oncol Biol Phys 2002;52:614–9CrossRefPubMed
9.
go back to reference Brito RA, Valero V, Buzdar AU, et al. Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastasis: the University of Texas M.D. Anderson Cancer Center experience. J Clin Oncol 2001;19:628–33PubMed Brito RA, Valero V, Buzdar AU, et al. Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastasis: the University of Texas M.D. Anderson Cancer Center experience. J Clin Oncol 2001;19:628–33PubMed
10.
go back to reference Olivotto IA, Chua B, Allan SJ, et al. Long-term survival of patients with supraclavicular metastases at diagnosis of breast cancer. J Clin Oncol 2003;21:851–4CrossRefPubMed Olivotto IA, Chua B, Allan SJ, et al. Long-term survival of patients with supraclavicular metastases at diagnosis of breast cancer. J Clin Oncol 2003;21:851–4CrossRefPubMed
11.
go back to reference Clemons M, Danson S, Hamilton T, et al. Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev 2001;27:67–82CrossRefPubMed Clemons M, Danson S, Hamilton T, et al. Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev 2001;27:67–82CrossRefPubMed
12.
go back to reference Voss M, Schneider JW, Apffelstaedt J. Axillary lymph node involvement in stage III breast cancer: treatment implications. J Surg Oncol 1999;(Suppl 71):162–6 Voss M, Schneider JW, Apffelstaedt J. Axillary lymph node involvement in stage III breast cancer: treatment implications. J Surg Oncol 1999;(Suppl 71):162–6
13.
go back to reference Axelsson CK, Rank F, Blichert-Toft M. Impact of axillary dissection on staging and regional control in breast tumor < or = 10 mm: the DBCG experience. Acta Oncol 2000;39:283–9CrossRefPubMed Axelsson CK, Rank F, Blichert-Toft M. Impact of axillary dissection on staging and regional control in breast tumor < or = 10 mm: the DBCG experience. Acta Oncol 2000;39:283–9CrossRefPubMed
14.
go back to reference Tocchi A, Mazzoni G, Bettelli E, et al. Impact of axillary level I and II lymph node dissection on the therapy of stage I and II breast cancer. Panminerva Med 2001;43:103–7PubMed Tocchi A, Mazzoni G, Bettelli E, et al. Impact of axillary level I and II lymph node dissection on the therapy of stage I and II breast cancer. Panminerva Med 2001;43:103–7PubMed
15.
go back to reference Picrquin B, Mazeron JJ, Glaubiger D. Conservative treatment of breast cancer in Europe. Radiother Oncol 1986;6:187–98 Picrquin B, Mazeron JJ, Glaubiger D. Conservative treatment of breast cancer in Europe. Radiother Oncol 1986;6:187–98
16.
go back to reference Recht A, Gray R, Davidson NE, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 1999;17:1689–700PubMed Recht A, Gray R, Davidson NE, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 1999;17:1689–700PubMed
17.
go back to reference Ellis H, Colborn GL, Skandalakis JE. Surgical embryology and anatomy of the breast and its related anatomic structures. Surg Clin North Am 1993;73:611–32PubMed Ellis H, Colborn GL, Skandalakis JE. Surgical embryology and anatomy of the breast and its related anatomic structures. Surg Clin North Am 1993;73:611–32PubMed
18.
go back to reference Skandalakis LJ, Vohman MD, Skandalakis JE, et al. The axillary lymph nodes in radical and modified radical mastectomy. Am Surg 1979;45:552–5PubMed Skandalakis LJ, Vohman MD, Skandalakis JE, et al. The axillary lymph nodes in radical and modified radical mastectomy. Am Surg 1979;45:552–5PubMed
19.
go back to reference Veronesi U, Luini A, Galimberti V, et al. Extent of metastatic axillary involvement in 1446 cases of breast cancer. Eur J Surg Oncol 1990;16:127–33PubMed Veronesi U, Luini A, Galimberti V, et al. Extent of metastatic axillary involvement in 1446 cases of breast cancer. Eur J Surg Oncol 1990;16:127–33PubMed
20.
go back to reference Nathanson SD, Wachna DL, Gilman D, et al. Pathways of lymphatic drainage from the breast. Ann Surg Oncol 2001;8:837–43CrossRefPubMed Nathanson SD, Wachna DL, Gilman D, et al. Pathways of lymphatic drainage from the breast. Ann Surg Oncol 2001;8:837–43CrossRefPubMed
21.
go back to reference Nemoto T, Vana J, Bedwani RN, et al. Management and survival of female breast cancer: results of a national survey by the American College of Surgeons. Cancer 1980;45:2917–24CrossRefPubMed Nemoto T, Vana J, Bedwani RN, et al. Management and survival of female breast cancer: results of a national survey by the American College of Surgeons. Cancer 1980;45:2917–24CrossRefPubMed
22.
go back to reference Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63:181–7CrossRefPubMed Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63:181–7CrossRefPubMed
23.
go back to reference Tienhoven GV, Borger JH, Passchier DH, et al. The prognostic significance of the axillary apex biopsy in clinically operable breast cancer. Eur J Cancer 1995;31:1965–8CrossRef Tienhoven GV, Borger JH, Passchier DH, et al. The prognostic significance of the axillary apex biopsy in clinically operable breast cancer. Eur J Cancer 1995;31:1965–8CrossRef
24.
go back to reference Cheng JC, Chen CM, Liu MC, et al. Locoregional failure of postmastectomy patients with 1–3 positive axillary lymph nodes without adjuvant radiotherapy. Int J Radiat Oncol 2002;52:980–8CrossRef Cheng JC, Chen CM, Liu MC, et al. Locoregional failure of postmastectomy patients with 1–3 positive axillary lymph nodes without adjuvant radiotherapy. Int J Radiat Oncol 2002;52:980–8CrossRef
25.
go back to reference Jatoi I, Hilsenbeck SG, Clark GM, et al. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol 1999;17:2334–40PubMed Jatoi I, Hilsenbeck SG, Clark GM, et al. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol 1999;17:2334–40PubMed
26.
go back to reference Canavese G, Catturich A, Vecchio C, et al. Prognostic role of lymph-node level involvement in patients undergoing axillary dissection for breast cancer. Eur J Surg Oncol 1998;24:104–9CrossRefPubMed Canavese G, Catturich A, Vecchio C, et al. Prognostic role of lymph-node level involvement in patients undergoing axillary dissection for breast cancer. Eur J Surg Oncol 1998;24:104–9CrossRefPubMed
27.
go back to reference Zurrida S, Morabito A, Galimberti V, et al. Importance of the level of axillary involvement in relation to traditional variables in the prognosis of breast cancer. Int J Oncol 1999;15:475–80PubMed Zurrida S, Morabito A, Galimberti V, et al. Importance of the level of axillary involvement in relation to traditional variables in the prognosis of breast cancer. Int J Oncol 1999;15:475–80PubMed
28.
go back to reference Clemons M, Hamilton T, Goss P. Does treatment at the time of locoregional failure of breast cancer alter prognosis? Cancer Treat Rev 2001;27:83–97CrossRefPubMed Clemons M, Hamilton T, Goss P. Does treatment at the time of locoregional failure of breast cancer alter prognosis? Cancer Treat Rev 2001;27:83–97CrossRefPubMed
29.
go back to reference Lê MG, Arriagada R, Spielmann M, et al. Prognostic factors for death after an isolated local recurrence in patients with early-stage breast carcinoma. Cancer 2002;94:2813–20CrossRefPubMed Lê MG, Arriagada R, Spielmann M, et al. Prognostic factors for death after an isolated local recurrence in patients with early-stage breast carcinoma. Cancer 2002;94:2813–20CrossRefPubMed
30.
go back to reference Pergolizzi S, Settineri N, Russi EG, et al. Supraclavicular lymph node metastases (SLM) from breast cancer as only site of distant disease: has radiotherapy any role? Anticancer Res 1997;17:2303–8PubMed Pergolizzi S, Settineri N, Russi EG, et al. Supraclavicular lymph node metastases (SLM) from breast cancer as only site of distant disease: has radiotherapy any role? Anticancer Res 1997;17:2303–8PubMed
31.
go back to reference Khan SA, Stewart AK, Morrow M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 2002;132:620–7CrossRefPubMed Khan SA, Stewart AK, Morrow M. Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 2002;132:620–7CrossRefPubMed
32.
go back to reference Vicini FA, Kestin L, Huang R, et al. Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy? Cancer 2003;97:910–9CrossRefPubMed Vicini FA, Kestin L, Huang R, et al. Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy? Cancer 2003;97:910–9CrossRefPubMed
33.
go back to reference Noguchi M. Does regional treatment improve the survival in patients with operable breast cancer? Br Cancer Res Treat 2002;76:269–82CrossRef Noguchi M. Does regional treatment improve the survival in patients with operable breast cancer? Br Cancer Res Treat 2002;76:269–82CrossRef
34.
go back to reference Rauschecker H, Clarke M, Gatzemeier W, et al. Systemic therapy for treating locoregional recurrence in women with breast cancer. Cochrane Database Syst Rev 2001:4 Rauschecker H, Clarke M, Gatzemeier W, et al. Systemic therapy for treating locoregional recurrence in women with breast cancer. Cochrane Database Syst Rev 2001:4
Metadata
Title
Prognosis of Breast Cancer After Supraclavicular Lymph Node Metastasis: Not a Distant Metastasis
Authors
Shin-Cheh Chen, MD
Hsien-Kun Chang, MD
Yung-Chang Lin, MD
Wai-Man Leung, MD
Chien-Sheng Tsai, MD
Yun-Chung Cheung, MD
Swei Hsueh, MD
Lai-Chu See, PhD
Miin-Fu Chen, MD, FACS
Publication date
01-11-2006
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9012-1

Other articles of this Issue 11/2006

Annals of Surgical Oncology 11/2006 Go to the issue