Objective: In this study, we evaluated the effect of supraclavicular lymph node dissection in breast cancer patients who presented with ipsilateral supraclavicular lymph node metastasis (ISLM) without distant metastasis. Methods: A total of 90 patients with synchronous ISLM without distant metastasis between 2000 and 2009 were retrospectively analyzed. Patients were retrospectively divided into two groups, namely supraclavicular lymph node dissection group(34 patients) and non-dissection group(56 patients), according to whether they underwentsupraclavicular lymph node dissection or not.The Kaplan-Meier method was applied to analyze the locoregional relapse free survival (LRFS) and overall survival(OS). Results: Median follow-upwas 85 months(range, 6 to 11 months). Local recurrence in 32 cases, 47 cases of distant metastasis, of which 25 patients were accompanied by both locoregional relapse and distant metastasis. Of the 32 patients with locoregional relapse, 11 patients were in the lymph node dissection group and 21 patients in the control group. Of the 47 patients with distant metastases, 17 were treated with lymph node dissection, 30 in the control group. Thirty-two patients died in the whole group and 16 patients underwentlymph node dissection and 16 patients didn't. There was no significant difference between the rate of 5-year LRFS and 5-year OS (P=0.359, P=0.246). For patients of ER negative, the 5-year loco-regional relapse free survival rates were 63.7% and 43.3% in supraclavicular lymph node dissection group and control group, respectively. The 5-year overall survival rates were 52.1% and 52.3%, respectively, and there were no statistically significant differences (P=0.118, P=0.951). For patients of PR negative, the 5-yearloco-regional relapse free rates were 59.8% and 46.2%, respectively, and the 5-year overall survival rates were 50.6% and 43.2%, respectively, and there was no significant difference between the two groups (P=0.317, P=0.973). The 5-year recurrence-free survival rates of human epidermal growth factor receptor 2 (HER2)-positive patients were 61.2% and 48.0%(P=0.634), respectively, and the 5-year overall survival rates were 37.2% and 65.4%(P=0.032). Forty-seven patients suffered distant metastases and the 5-year metastases free survival rates were 37.3% and 38.5% in supraclavicular lymph node dissection group and control group, respectively. Conclusion: Supraclavicular lymph node dissection maybe an effective approach to improve the loco-regional control for the patients with ISLM, especially for ER negative and PR negative subtypes, but it might has adverseeffects for the patients with negative HER2 status.
目的： 探讨锁上淋巴结清扫术在初诊时锁上淋巴结转移乳腺癌患者治疗中的作用。 方法： 回顾性分析2000年至2009年间90例初诊伴有锁上淋巴结转移而无远处转移的乳腺癌患者临床资料，根据患者是否进行了锁上淋巴结清扫术分为锁上淋巴结清扫组(34例)和对照组(56例)。 结果： 90例患者的随访时间为6～111个月，中位随访时间为85个月。局部区域复发32例，远处转移47例，其中有25例患者同时伴有局部区域复发和远处转移。32例局部复发患者中，锁上淋巴结清扫组11例，对照组21例。47例远处转移患者中，锁上淋巴结清扫组17例，对照组30例。90例患者中，死亡32例，其中锁上淋巴结清扫组16例，对照组16例。生存分析显示，锁上淋巴结清扫组和对照组患者的无复发生存率和生存率差异无统计学意义(P＝0.359，P＝0.246)。锁上淋巴结清扫组和对照组雌激素受体(ER)阴性患者的5年无复发生存率分别为63.7%和43.3%，5年生存率分别为52.1% 和52.3%，差异均无统计学意义(P＝0.118，P＝0.951)。锁上淋巴结清扫组和对照组孕激素受体(PR)阴性患者的5年无复发生存率分别为59.8% 和46.2%，5年生存率分别为50.6%和43.2% ，差异均无统计学意义( P＝0.317，P＝0.973)。锁上淋巴结清扫组和对照组人表皮生长因子受体2(HER2)阴性患者的5年无复发生存率分别为61.2%和48.0%, 5年生存率分别为37.2%和65.4%, 差异均无统计学意义(P＝0.634, P＝0.032)。全组有47例患者发生远处转移，锁上淋巴结清扫组和对照组患者的5年无转移生存率分别为37.3%和38.5%。 结论： 锁上淋巴结清扫术可能是ER阴性、PR阴性且初诊伴有锁上淋巴结转移的乳腺癌患者局部控制的有效手段，可能不利于HER2阴性且初诊伴有锁上淋巴结转移的乳腺癌患者的总生存时间延长。.
Keywords: Breast neoplasms; Ipsilateral supraclavicular lymph node metastasis; Molecular subtype; Prognosis; Supraclavicular lymph node dissection.