To explore the risk factors of supraclavicular lymph node positive after neoadjuvant chemotherapy in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis, and analyze the prognosis of those patients.

A total of 96 breast cancer patients in the Department of Breast and Thyroid Surgery, Southwest Hospital, Army Medical University from January 2005 to July 2015 were enrolled in this retrospective study. The imaging findings indicated synchronous ipsilateral supraclavicular lymph node metastasis in all patients. All patients were treated with preoperative neoadjuvant chemotherapy of 4-6 cycles, radiotherapy, modified radical mastectomy and ipsilateral supraclavicular lymph node dissection. Moreover, the patients with ER, PR or HER-2 positive received the endocrine therapy and targeted therapy, respectively. χ² test and Fisher exact probability test were used to analyze the relationship between clinicopathological characteristics and positive ipsilateral supraclavicular lymph nodes after neoadjuvant chemotherapy. Logistic regression was used to analyze the risk factors of positive ipsilateral supraclavicular lymph nodes after neoadjuvant chemotherapy. Kaplan-Meier survival curve was drawn to analyze the OS and DFS of all patients.

Postoperative pathology showed that among the 96 patients, 50 cases had positive supraclavicular lymph nodes, accounting for 53% of the total. Univariate analysis showed that the following clinicopathological characteristics were significantly different between ipsilateral supraclavicular lymph node-positive group and ipsilateral supraclavicular lymph node-negative group after neoadjuvant chemotherapy: number of positive axillary lymph nodes, supraclavicular lymph nodes, internal mammary lymph nodes and Ki67 (χ²=36.501, 20.548, 6.750, 5.186, all P<0.050). Multivariate analysis showed that the number of positive axillary lymph nodes≥4 was an independent risk factor for synchronous ipsilateral supraclavicular lymph node metastasis (4-9 nodes: OR=10.234, 95%CI: 1.978-52.946, P=0.006; >9 nodes: OR=22.322, 95%CI: 4.887-101.963, P<0.001). The 3-year DFS and OS of 96 patients were 64.7% and 75.8%, respectively; the 5-year DFS and OS were 49.6% and 65.0%, respectively.

The number of positive axillary lymph nodes after neoadjuvant chemotherapy≥4 is a high risk factor for synchronous ipsilateral supraclavicular lymph node metastasis in breast cancer patients. If the imaging evidences suggest synchronous ipsilateral supraclavicular lymph node metastasis, local treatment (breast, axillary and supraclavicular surgery+ radiation therapy) combined with systemic therapy (chemotherapy+ endocrine/targeted therapy if necessary) are recommended in order to improve the survival of patients.