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Supraclavicular Lymph Node Dissection in Breast Cancer with Synchronous Supraclavicular Metastases: A Systematic
George Shiyao He1, Jolene Li Ling Chia1, Emmeline Elaine Cua-De Los Santos2
1NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
Cancers
|July 12, 2025
Summary
Selective supraclavicular lymph node dissection (SLND) may improve survival in breast cancer patients with synchronous ipsilateral metastases when limited to level V. Broader SLND approaches should be used cautiously.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Synchronous ipsilateral supraclavicular lymph node metastases (sISLMs) in breast cancer are rare and linked to poor prognosis.
- Optimal locoregional treatment strategies for sISLMs, especially the role of supraclavicular lymph node dissection (SLND), are not well-defined.
Purpose of the Study:
- To systematically review and perform a network meta-analysis comparing outcomes of different locoregional treatment strategies for sISLMs in breast cancer.
- To evaluate the impact of supraclavicular lymph node dissection (SLND) combined with radiotherapy (RT) and systemic therapy (ST) versus other treatment modalities.
Main Methods:
- A systematic review and network meta-analysis of studies published up to December 2023.
- Inclusion of ten studies (3346 patients) for overall survival (OS) and six for disease-free survival (DFS) analysis.
- Comparison of SLND + RT + ST, SLND + ST, and ST alone, with RT + ST as the reference group.
Main Results:
- SLND + RT + ST demonstrated comparable OS and DFS to RT + ST alone.
- Selective SLND limited to level V was associated with improved OS (HR: 0.47).
- More extensive SLND (level V+) was linked to worse outcomes (HR: 1.41).
Conclusions:
- Selective SLND may offer survival benefits for specific breast cancer patients with sISLMs.
- Wider application of SLND should be approached with caution, awaiting further evidence from randomized trials.
