J Breast Cancer.  2020 Apr;23(2):194-204. 10.4048/jbc.2020.23.e14.

Cervical Lymph Node Involvement above the Supraclavicular Fossa in Breast Cancer: Comparison with Stage IIIC (KROG 18-02)

Affiliations
  • 1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
  • 3Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 4Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
  • 5Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 6Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • 7Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
  • 8Department of Radiation Oncology, Wonju Severance Christian Hospital, Wonju, Korea
  • 9Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
  • 10Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
  • 11Department of Radiation Oncology, Jeonbuk National University Hospital, Jeonju, Korea
  • 12Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea

Abstract

Purpose
We aimed to analyze the treatment outcomes of ipsilateral cervical lymph node (CLN)-positive breast cancer without other distant metastasis and compare the outcomes with those of supraclavicular lymph node (SCL)-positive breast cancer.
Methods
Seventy-eight patients with breast cancer and ipsilateral CLN metastasis above the supraclavicular fossa (CLN[+] group) were treated at 7 institutions (2000–2014). Seventy-four patients received systemic chemotherapy and breast surgery followed by locoregional radiotherapy. Outcomes of the CLN(+) group were compared with those of the SCL(+) group, which included 183 patients with SCL involvement.
Results
The median follow-up duration was 55.9 months. Twenty-two regional failures were found in 15 patients—axillary lymph node (LN) in 8, SCL in 6, internal mammary LN in 3, previously involved CLN in 4, and previously uninvolved ipsilateral CLN in one patient. The 5-year overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates were 68.6%, 46.7%, 68.4%, and 57.0%, respectively. Neck dissection did not improve LRRFS and DFS (p = 0.86 and p = 0.26, respectively). Multivariate analysis showed that hormone receptor negativity and the presence of extracapsular extension were prognostic factors for poor DFS. On comparison with stage IIIC using propensity score matching, survival outcomes of the CLN(+) and SCL(+) groups were not different (5-year OS, p = 0.75; DFS, p = 0.88; LRRFS, p = 0.86; and DMFS, p = 0.45).
Conclusion
The comparable clinical outcomes indicate that patients with breast cancer who have ipsilateral CLN metastasis without other distant metastasis may benefit from locoregional treatment of the ipsilateral breast and systemic therapies, as do those with N3c disease.

Keyword

Breast; Carcinoma; Neoplasm metastasis; Survival; Neoplasm staging
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