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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.
Background/Objectives:
Synchronous ipsilateral supraclavicular lymph node metastases (sISLMs) in breast cancer are rare and associated with poor prognosis. The optimal locoregional treatment strategy remains unclear, particularly regarding the role of supraclavicular lymph node dissection (SLND).
Methods:
We conducted a systematic review and network meta-analysis, including studies published up to end December 2023, to compare the outcomes of SLND combined with radiotherapy (RT) and systemic therapy (ST), SLND with ST alone, and ST alone, using RT + ST as the reference.
Results:
Ten studies involving 3346 patients were included for overall survival (OS) analysis, and six studies were included for disease-free survival (DFS). SLND + RT + ST showed similar OS and DFS compared to RT + ST. Sensitivity analyses revealed that SLND limited to level V improved OS (HR: 0.47, 95% CI: 0.29-0.77), while more extensive dissections (level V+) worsened outcomes (HR: 1.41, 95% CI: 1.10-1.80).
Conclusions:
These findings suggest that selective SLND may benefit certain patients, but broader application should be approached with caution pending results from future randomized trials.
