Predictive Factors for Supraclavicular Lymph Node Recurrence in N1 Breast Cancer Patients

Abstract

Background: The purpose of this study was to identify predictive factors for supraclavicular lymph node recurrence (SCLR) in N1 breast cancer patients and define a high-risk subgroup who might benefit from supraclavicular nodal radiotherapy (RT). Materials and Methods: From January 1995 to December 2009, 113 breast cancer patients with 1 to 3 positive axillary lymph nodes were enrolled in this study. All patients underwent breast-conserving surgery (BCS) or modified radical mastectomy (MRM). RT was given to all patients who received BCS. Among the patients given MRM, those with breast tumors >5 cm in size received RT. Regional nodal irradiation was not applied. Systemic chemotherapy was given to 105 patients (92.9%). Patient data were retrospectively reviewed and analyzed to identify predictive factors for SCLR. Results: The median follow-up duration was 6.5 years, with 5-and 10-year actuarial SCLR rates of 9.3% and 11.2%, respectively. Factors associated with SCLR on univariate analysis included histologic grade, number of dissected axillary lymph nodes, lymphovascular invasion, extracapsular extension (ECE), and adjuvant chemotherapy. On multivariate analysis, histologic grade and ECE remained significant. The patient group with grade 3 and ECE had a significantly higher rate of SCLR compared with the remainder (5-year SCLR rate; 71.4% vs. 4.0%, p<0.001). Conclusions: Histologic grade and ECE status are significant predictive factors for SCLR. Supraclavicular nodal RT is necessary in N1 breast cancer patients featuring histologic grade 3 and ECE.

Benefit of Post-mastectomy Radiotherapy of the Supra-/infraclavicular Lymphatic Drainage Area in Breast Cancer Patients

“…This suggests that patients receiving mastectomy due to T1-2N1M0 breast cancer should have postoperative RT targeted at the supra-/infraclavicular lymphatic drainage area. A similar conclusion was reached in a study of 113 breast cancer patients with 1 to 3 positive axillary lymph nodes who underwent BCS or modified radical mastectomy (MRM) (Kong and Hong, 2013). Kong et al (2013) also concluded that supraclavicular nodal RT was necessary in N1 breast cancer patients.…”

“…A similar conclusion was reached in a study of 113 breast cancer patients with 1 to 3 positive axillary lymph nodes who underwent BCS or modified radical mastectomy (MRM) (Kong and Hong, 2013). Kong et al (2013) also concluded that supraclavicular nodal RT was necessary in N1 breast cancer patients. However, they limited their therapeutic approach to only a high-risk subgroup of patients featuring histologic grade 3 and ECE.…”

“…Kong et al (2013) reported that patients with SCFR experienced significantly decreased DMFS and OS compared to patients who did not have SCFR. Siponen et al (2012) reported SCFR was an independent predictor of poor OS.…”

“…Guidelines of the National Comprehensive Cancer Network (NCCN) and the German Society for Radiooncology (DEGRO) recommend adjunctive RT in patients after mastectomy due to T1-2N1M0 breast cancer (Sautter-Bihl et al, 2008;National Comprehensive Cancer Network (NCCN), 2011). However, other studies, including the St. Gallen International Breast Cancer Conference, New Zealand Guidelines Group (NZGG), Chinese Anti-Cancer Association, and the European Society for Medical Oncology (ESMO), recommend adjunctive RT for patients with 1 to 3 positive ALN plus the presence of other risk factors, such as young age, negative estrogen receptor (ER) status, dissection of a small number of ALN, positive nodal ratio, lymphovascular invasion (LVI), extracapsular extension, and high nuclear grade (New Zealand Guidelines Group (NZGG), 2009;Aebi et al, 2011;Goldhirsch et al, 2011; Professional Committee of Breast Cancer of Chinese Anti-Cancer Association, 2011; Huang et al, 2012;Kong and Hong, 2013).…”

“…Studies have reported that SCFR can significantly reduce survival, making prevention of SCFR very important (Kong and Hong, 2013). SCFR rates have been shown to vary from as low as 1.…”