Comparison of Survival Outcomes Among Patients With Breast Cancer With Distant vs Ipsilateral Supraclavicular Lymph Node Metastases

Pan, Hong; Wang, Hui; Qian, Mengjia; Mao, Xiao‐Ming; Shi, Guo-Jian; Ma, Ge; Yu, Mengxue; Xie, Hui; Ling, Lijun; Ding, Qiang; Zhang, Kai; Wang, Shui; Zhou, Wenbin

doi:10.1001/jamanetworkopen.2021.1809

Cited by 20 publications

(23 citation statements)

References 29 publications

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“…Our data demonstrated that in multimodal therapy, SND in addition to systemic therapy was associated with overall survival improvement when compared with no surgery, and the results are consistent with recent studies showing that long-term survival outcomes of patients with sSLNM were improved by multimodal therapy with curative intent [ 22 , 23 ]. As intensive clinical surveillance with modern imaging modalities, such as sonography, to detect subclinical distant nodal relapse earlier and multimodal therapy, including SND and systemic therapy, were associated with improved 5-year DMFS, RFS, and OS, we can treat miSLNM as locoregional relapse rather than systemic metastasis.…”

Section: Discussionsupporting

confidence: 90%

“…On the contrary, miSLNM and contralateral axillary lymph node metastasis (CAM) are staged as rN3c or M1 disease (in our series, most of the locations of metastatic nodes were beyond the triangle of supraclavicular fossa and involved the level III and IV and even level V of neck), while many studies have demonstrated that both miSLNM and CAM are associated with a better prognosis than distant metastasis if managed with intensive multimodal therapy with curative intent [ 18 , 20 , 22 , 25 ]. Surgical removal of miSLNM is usually neglected in multimodal therapy because it is categorized as systemic disease with inconsistent survival benefit of surgical treatment.…”

Section: Discussionmentioning

confidence: 91%

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Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

Chen

Shen

et al. 2021

Cancers

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We retrospectively enrolled 139 patients who developed metachronous isolated supraclavicular lymph node metastasis (miSLNM) from 8129 consecutive patients who underwent primary surgery between 1990 and 2008 at a single medical center. The median age was 47 years. The median follow-up time from date of primary tumor surgery was 73.1 months, and the median time to the date of neck relapse was 43.9 months in this study. Sixty-one (43.9%) patients underwent selective neck dissection (SND). The 5-year distant metastasis-free survival (DMFS), post-recurrence survival, and overall survival (OS) rates in the SND group were 31.1%, 40.3%, and 68.9%, respectively, whereas those of the no-SND group were 9.7%, 32.9%, and 57.7%, respectively (p = 0.001). No SND and time interval from primary tumor surgery to neck relapse ≤24 months were the only significant risk factors in the multivariate analysis of DMFS (hazard ratio (HR), 1.77; 95% confidence interval (CI), 1.23–2.56; p = 0.002 and HR, 1.76, 95% CI, 1.23–2.52; p = 0.002, respectively) and OS (HR, 1.77; 95% CI, 1.22–2.55; p = 0.003 and HR, 3.54, 95% CI, 2.44–5.16; p < 0.0001, respectively). Multimodal therapy, including neck dissection, significantly improved the DMFS and OS of miSLNM. Survival improvement after miSLNM control by intensive surgical treatment suggests that miSLNM is not distant metastasis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 91%

Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

Chen

Shen

et al. 2021

Cancers

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“…Lymph nodes are the central transport center of circulating immune cells, with the lymphatic drainage system of the body a coherent whole separated by particular anatomical boundaries (10)(11)(12). Patients with extra-regional lymph node metastasis are considered to have better prognosis than those with solid organ metastasis among some metastatic malignancies.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with extra-regional lymph node metastasis are considered to have better prognosis than those with solid organ metastasis among some metastatic malignancies. The research by Hong Pan showed that patients with distant lymph node metastasis (DLNM) had similar breast cancer-specific survival (BCSS) and OS as those with ipsilateral supraclavicular lymph node metastasis (ISLM), whereas those with distant metastasis (not DLNM) had significantly poorer BCSS and OS (12). Similarly, Francesca Magnoni found that although contralateral axillary lymph node metastasis after treatment belongs to distant metastasis (distant lymph node metastasis), its OS is significantly better than the distant metastasis of other organs (13).…”

Section: Discussionmentioning

confidence: 99%

Subphrenic Lymph Node Metastasis Predicts Poorer Prognosis for Nasopharyngeal Carcinoma Patients With Metachronous Metastasis

Zhang

Liang

et al. 2021

Front. Oncol.

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AimWe retrospectively analyzed the distribution of distant lymph node metastasis and its impact on prognosis in patients with metastatic NPC after treatment.MethodsFrom 2010 to 2016, 219 NPC patients out of 1,601 (182 from the Affiliated Cancer Hospital and Institute of Guangzhou Medical University, and 37 from the Affiliated Dongguan Hospital, Southern Medical University) developed distant metastasis after primary radiation therapy. Metastatic lesions were divided into groups according to location: bones above the diaphragm (supraphrenic bone, SUP-B); bones below the diaphragm (subphrenic bone, SUB-B); distant lymph nodes above the diaphragm (supraphrenic distant lymph nodes, SUP-DLN); distant lymph nodes below the diaphragm (subphrenic distant lymph nodes, SUB-DLN), liver, lung, and other lesions beyond bone/lung/distant lymph node above the diaphragm (supraphrenic other lesions, SUP-OL); other lesions beyond bone/liver/distant lymph node below the diaphragm (subphrenic other lesions, SUB-OL); the subtotal above the diaphragm (supraphrenic total lesions, SUP-TL); and the subtotal below the diaphragm (subphrenic total lesions, SUB-TL). Kaplan–Meier methods were used to estimate the probability of patients’ overall survival (OS). Univariate and multivariate analyses were applied using the Cox proportional hazard model to explore prediction factors of OS.ResultsThe most frequent metastatic locations were bone (45.2%), lung (40.6%), liver (32.0%), and distant lymph nodes (20.1%). The total number of distant lymph node metastasis was 44, of which 22 (10.0%) were above the diaphragm, 18 (8.2%) were below the diaphragm, and 4 (1.8%) were both above and below the diaphragm. Age (HR: 1.02, 95% CI: 1.00, 1.03, p = 0.012), N stage (HR: 1.26, 95% CI: 1.04, 1.54, p = 0.019), number of metastatic locations (HR: 1.39, 95% CI: 1.12, 1.73, p = 0.003), bone (HR: 1.65, 95% CI: 1.20, 2.25, p = 0.002), SUB-B (HR: 1.51, 95% CI: 1.07, 2.12, p = 0.019), SUB-DLN (HR: 1.72, 95% CI: 1.03, 2.86, p = 0.038), and SUB-O L(HR: 4.46, 95% CI: 1.39, 14.3, p = 0.012) were associated with OS. Multivariate analyses revealed that a higher N stage (HR: 1.23, 95% CI: 1.00, 1.50, p = 0.048), SUB-DLN (HR: 1.72, 95% CI: 1.02, 2.90, p = 0.043), and SUB-OL (HR: 3.72, 95% CI: 1.14, 12.16, p = 0.029) were associated with worse OS.ConclusionSubphrenic lymph node metastasis predicts poorer prognosis for NPC patients with metachronous metastasis; however, this needs validation by large prospective studies.

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“…The patients with distant lymph node metastasis were once considered as surgical contraindication [3]. But according to Hong Pan et al [4], patients with distant lymph node metastases (DLNM) had similar breast cancer-speci c survival (BCSS) and overall survival (OS) with patients with ipsilateral supraclavicular lymph node metastases (ISLM) and locoregional therapies were signi cantly associated with improved overall survival for patients with DLNM. We herein present a case of breast cancer with contralateral neck lymph node metastasis of a 30-year-old woman, exhibit its clinical, morphological, pathological and immunohistochemical characteristics and discuss its treatment combined with current research.…”

Section: Introductionmentioning

confidence: 99%

Breast Cancer Combined with Contralateral Neck Lymph Node Metastasis. Case Report

Zhong

Ding

Liu

et al. 2021

Preprint

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Background: Contralateral neck lymph node metastasis is rare for primary breast cancer. Its clinical stage and treatment principles are lack of authoritative guidelines. A 30-year-old breast cancer patient with contralateral neck lymph node metastasis is presented. The clinical treatment is discussed combined with current research.Case presentation: A 30-year-old woman presented with a right breast mass for 5 months and left neck lymph node enlargement for 5 days. The mammography showed a 33mm*14.3mm mass in the inner quadrant of right breast. The ultrasound showed several hypoechoic nodules on the left side of the neck. Rapid intraoperative pathological examination diagnosed right breast malignant tumor and poorly differentiated carcinoma of the left cervical lymph nodes. Then the right mastectomy was performed immediately. The patient was scheduled to administer chemotherapy, molecular targeted therapy, radiotherapy and endocrinotherapy after operation. The long-term efficacy remains to be seen.Conclusion: The infrequent presentation of breast cancer with metastasis to the contralateral neck lymph node can be challenged for standard therapies.

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Comparison of Survival Outcomes Among Patients With Breast Cancer With Distant vs Ipsilateral Supraclavicular Lymph Node Metastases

Cited by 20 publications

References 29 publications

Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

Subphrenic Lymph Node Metastasis Predicts Poorer Prognosis for Nasopharyngeal Carcinoma Patients With Metachronous Metastasis

Breast Cancer Combined with Contralateral Neck Lymph Node Metastasis. Case Report

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