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Effectiveness of Neck Lymph Node Dissection for Breast Cancer Patients with Isolated Supraclavicular Nodal Recurrence
Hiroshi Isozaki1, Yasuhisa Yamamoto1, Shigeki Murakami1
1Department of Surgery, Oomoto Hospital, Okayama, 700-0924, Japan.
Background:
Isolated supraclavicular nodal recurrence (ISNR) is a rare form of recurrence and is regarded as a precursor of a poor prognosis. The surgical removal of ISNR is typically neglected in multimodal therapy.
Patients And Methods:
Among 5279 consecutive patients who underwent primary breast cancer surgery at a single hospital between 1977 and 2011, INSR was observed in 77 patients (1.5%). Two INSR patients whose fate was unknown were excluded from the present analysis. Therefore, 75 patients with ISNR treated with (n=58) or without (n=17) neck lymph node dissection (NLND) were evaluated.
Results:
Overall survival rates were significantly higher in the NLND group than in the no-NLND group (p = 0.0027). Five- and 10-year survival rates were 64.8 and 47.2%, respectively, in the NLND group and 35.3 and 11.7%, respectively, in the no-NLND group. In a Cox proportional hazards regression (stepwise selection) analysis in which the time interval from the primary surgery to ISNR was excluded, the T factor (T2, 3 vs. T1, hazard ratio 2.26) and NLND (yes vs. no, hazard ratio 0.41) were identified as significant factors affecting OS rates. When the time interval from primary surgery to ISNR was included, the interval from the primary surgery to ISNR (>2 years) and NLND were identified as significant factors for long OS (HR 0.21, HR 0.39).
Conclusion:
ISNR is type of a loco-regional recurrence, and NLND needs to be considered in multimodal (radiation and systemic chemo-) therapy.
