Prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastasis treated by surgery combined with radiotherapy

doi:10.3877/cma.j.issn.1674-0807.2022.01.003

Abstract

Abstract:

Objective

To explore the prognostic factors for breast cancer patients with ipsilateral supraclavicular lymph node metastasis receiving surgical dissection of supraclavicular lymph nodes combined with radiotherapy.

Methods

The clinical data of 68 breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis in the Department of Radiotherapy, Fourth Hospital of Hebei Medical University from December 2009 to March 2015 were retrospectively analyzed. The local treatment of metastatic supraclavicular lymph node was supraclavicular lymph nodes dissection combined with radiotherapy in all patients. The main indicators were locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and OS. The Kaplan-Meier method and Log-rank test were used for univariate analysis. The Cox proportional hazard regression model was used for multivariate analysis.

Results

The median follow-up was 92 months (58-122 months). The 5-year LRFS, DMFS, PFS and OS rate of all patients were 79.2%, 65.8%, 55.8% and 64.7%, respectively. Multivariate analysis found that the number of metastatic axillary lymph nodes ≥ 10 was a risk factor for 5-year DMFS (compared with patients with no axillary lymph node metastasis: HR=8.151, 95%CI: 1.011-65.726, P=0.049); Ki-67> 30%, number of dissected supraclavicular lymph nodes≥10 and number of metastatic supraclavicular lymph nodes ≥2 were risk factors for 5-year PFS (HR: 6.674, 95%CI: 2.291-19.443, P=0.001; HR: 2.605, 95%CI: 1.039-6.528, P=0.041; HR: 2.958, 95%CI: 1.155-7.577, P=0.024). If the number of dissected supraclavicular lymph nodes was less than 10, no significant difference was found in 5-year LRFS, DMFS, PFS and OS rate between patients receiving supraclavicular radiotherapy dose of 50 Gy and patients receiving supraclavicular radiotherapy dose > 50 Gy(χ²=0.117, 1.735, 2.754、3.073, all P>0.050). If the number of dissected supraclavicular lymph nodes was no less than 10, the patients receiving supraclavicular radiotherapy dose of 50 Gy had a significantly higher 5-year DMFS rate compared with patients receiving supraclavicular radiotherapy dose >50 Gy(χ²=4.808, P=0.028).

Conclusion

For breast cancer patients with ipsilateral supraclavicular lymph node metastasis, the number of dissected supraclavicular lymph nodes ≥ 10 and number of metastatic supraclavicular lymph nodes ≥2 indicate a poor PFS, and the increase of supraclavicular radiotherapy dose cannot improve the prognosis of patients.

Key words: Breast neoplasms, Clavicle, Lymph node excision, Neoplasm metastasis, Radiotherapy, Prognosis

Xiaohong Li, Andu Zhang, Huina Han, Deyou Kong, Jian Zhang, Xuejuan Duan, Jie Kong, Fuyin Qu, Kaiye Du, Jun Zhang, Zhikun Liu. Prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastasis treated by surgery combined with radiotherapy[J]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(01): 14-22.

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Figures/Tables 9

References 31

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影响因素	变量类型	变量分类及赋值
初诊年龄	X₁	≤50岁＝0，>50岁＝1
是否绝经	X₂	未绝经＝0，绝经＝1
临床肿瘤长径	X₃	≤2 cm＝1，>2~5 cm＝2，>5 cm＝3
肿瘤侵及皮肤或胸肌	X₄	否＝0，是＝1
T分期	X₅	T_1~2＝1，T_3~4＝2
内乳淋巴结	X₆	阴性＝0，阳性＝1
锁骨上淋巴结化疗后是否CR	X₇	否＝0，是＝1
锁骨上淋巴结清扫数目	X₈	<10枚＝0，≥10枚＝1
锁骨上淋巴结转移数目	X₉	<2枚＝0，≥2枚＝1
锁骨上淋巴结转移度	X₁₀	≤20%＝0，>20%＝1
病理组织学分级	X₁₁	2级＝1，3级＝2
脉管瘤栓	X₁₂	无＝0，有＝1
腋窝淋巴结转移数目	X₁₃	0枚＝0，1~3枚＝1，4~9枚＝2，≥10枚＝3
腋窝淋巴结转移度	X₁₄	≤20%＝0，>20%＝1
ER/PR状态	X₁₅	阴性＝0，阳性＝1
HER-2状态	X₁₆	阴性＝0，阳性＝1
Ki-67	X₁₇	≤30%＝0，>30%＝1
是否靶向治疗	X₁₈	否＝0，是＝1
辅助内分泌治疗	X₁₉	否＝0，是＝1
新辅助化疗	X₂₀	无＝0，有＝1
锁骨上区放射治疗剂量	X₂₁	50 Gy＝0，>50 Gy＝1
LRFS	Y₁	无局部区域复发＝0，有局部区域复发＝1
DMFS	Y₂	无远处转移＝0，有远处转移＝1
PFS	Y₃	无进展＝0，有进展＝1
OS	Y₄	生存＝0，死亡＝1

影响因素	变量类型	变量分类及赋值
初诊年龄	X₁	≤50岁＝0，>50岁＝1
是否绝经	X₂	未绝经＝0，绝经＝1
临床肿瘤长径	X₃	≤2 cm＝1，>2~5 cm＝2，>5 cm＝3
肿瘤侵及皮肤或胸肌	X₄	否＝0，是＝1
T分期	X₅	T_1~2＝1，T_3~4＝2
内乳淋巴结	X₆	阴性＝0，阳性＝1
锁骨上淋巴结化疗后是否CR	X₇	否＝0，是＝1
锁骨上淋巴结清扫数目	X₈	<10枚＝0，≥10枚＝1
锁骨上淋巴结转移数目	X₉	<2枚＝0，≥2枚＝1
锁骨上淋巴结转移度	X₁₀	≤20%＝0，>20%＝1
病理组织学分级	X₁₁	2级＝1，3级＝2
脉管瘤栓	X₁₂	无＝0，有＝1
腋窝淋巴结转移数目	X₁₃	0枚＝0，1~3枚＝1，4~9枚＝2，≥10枚＝3
腋窝淋巴结转移度	X₁₄	≤20%＝0，>20%＝1
ER/PR状态	X₁₅	阴性＝0，阳性＝1
HER-2状态	X₁₆	阴性＝0，阳性＝1
Ki-67	X₁₇	≤30%＝0，>30%＝1
是否靶向治疗	X₁₈	否＝0，是＝1
辅助内分泌治疗	X₁₉	否＝0，是＝1
新辅助化疗	X₂₀	无＝0，有＝1
锁骨上区放射治疗剂量	X₂₁	50 Gy＝0，>50 Gy＝1
LRFS	Y₁	无局部区域复发＝0，有局部区域复发＝1
DMFS	Y₂	无远处转移＝0，有远处转移＝1
PFS	Y₃	无进展＝0，有进展＝1
OS	Y₄	生存＝0，死亡＝1

临床特征		例数	5年LRFS率(%)	χ²值	P值	5年DMFS率(%)	χ²值	P值	5年PFS率(%)	χ²值	P值	5年OS率(%)	χ²值	P值
初诊年龄
	≤50岁	41	79.1	0.005	0.944	76.7	5.818	0.016	64.5	3.773	0.052	70.7	2.051	0.152
	>50岁	27	80.0	0.005	0.944	48.6	5.818	0.016	42.4	3.773	0.052	55.6	2.051	0.152
是否绝经
	未绝经	40	78.6	0.011	0.918	70.8	1.081	0.299	61.0	0.998	0.318	70.0	0.367	0.545
	绝经	28	80.6	0.011	0.918	58.5	1.081	0.299	48.9	0.998	0.318	57.1	0.367	0.545
原发部位
	左乳	45	81.0	0.037	0.847	61.0	0.098	0.754	52.3	0.058	0.810	64.4	0.000	0.986
	右乳	23	76.3	0.037	0.847	74.9	0.098	0.754	62.5	0.058	0.810	65.2	0.000	0.986
原发肿瘤象限
	外	32	75.7	1.344	0.719	69.1	1.235	0.745	62.9	2.190	0.534	59.4	1.129	0.770
	内	4	75.0			100.0			75.0			75.0
	中央	28	80.7			56.9			42.9			64.3
	其他	4	100.0			75.0			75.0			100.0
临床肿瘤长径
	≤2 cm	10	100.0	3.011	0.222	80.0	1.135	0.567	80.0	2.446	0.294	90.0	3.822	0.148
	>2~5 cm	42	77.5			65.0			53.3			64.3
	>5 cm	16	68.8			57.3			46.9			50.0
肿瘤侵及皮肤或胸肌
	是	13	63.3	2.935	0.087	49.4	1.801	0.180	33.8	4.337	0.037	53.8	0.665	0.415
	否	55	82.5	2.935		69.4	1.801	0.180	60.7	4.337	0.037	67.3	0.665	0.415
	T分期
	T_1~2	44	83.9	1.604	0.205	72.2	0.891	0.345	63.3	1.771	0.183	70.5	1.598	0.206
	T_3~4	24	69.0	1.604	0.205	53.3	0.891	0.345	41.4	1.771	0.183	54.2	1.598	0.206
内乳淋巴结
	阳性	16	66.7	1.502	0.220	71.8	0.021	0.885	55.6	0.119	0.730	50.0	0.354	0.552
	阴性	52	83.4	1.502	0.220	63.6	0.021	0.885	55.8	0.119	0.730	69.2	0.354	0.552
锁骨上淋巴结诊断手段
	影像	22	84.2	0.779	0.377	65.5	0.495	0.482	57.3	0.596	0.440	63.6	0.097	0.755
	病理	46	76.7	0.779	0.377	65.9	0.495	0.482	55.2	0.596	0.440	65.2	0.097	0.755
锁骨上淋巴结化疗后是否CR
	是	28	88.5	2.231	0.135	85.1	6.374	0.012	78.0	8.363	0.004	82.1	7.368	0.007
	否	40	72.1	2.231	0.135	51.8	6.374	0.012	40.0	8.363	0.004	52.5	7.368	0.007
锁骨上淋巴结清扫数目
	<10枚	31	84.9	1.412	0.235	71.5	2.391	0.122	65.2	3.860	0.049	64.5	0.134	0.715
	≥10枚	37	74.6	1.412	0.235	61.5	2.391	0.122	48.6	3.860	0.049	64.9	0.134	0.715
锁骨上淋巴结转移数目
	<2枚	33	86.5	2.416	0.120	83.7	8.953	0.003	77.8	12.966	<0.001	72.7	3.268	0.071
	≥2枚	35	72.5	2.416	0.120	49.0	8.953	0.003	35.4	12.966	<0.001	57.1	3.268	0.071
锁骨上淋巴结转移度
	≤20%	33	83.5	0.981	0.322	83.7	6.518	0.011	74.9	8.046	0.005	72.7	3.495	0.062
	>20%	35	75.4	0.981	0.322	48.5	6.518	0.011	37.5	8.046	0.005	57.1	3.495	0.062
病理组织学分级
	2级	42	85.3	1.796	0.180	75.8	3.753	0.053	68.5	5.596	0.018	71.4	5.876	0.015
	3级	26	67.2	1.796	0.180	48.3	3.753	0.053	34.3	5.596	0.018	53.8	5.876	0.015
脉管瘤栓
	有	20	64.8	2.764	0.096	56.6	0.889	0.346	43.3	2.254	0.133	45.0	2.698	0.100
	无	48	84.6	2.764	0.096	69.2	0.889	0.346	61.0	2.254	0.133	72.9	2.698	0.100
腋窝淋巴结转移数目
	0枚	9	100.0	4.086	0.252	88.9	4.059	0.255	88.9	5.274	0.153	100.0	5.232	0.156
	1~3枚	12	61.4			81.8			61.4			58.3
	4~9枚	14	75.5			53.6			42.9			50.0
	≥10枚	33	80.0			58.7			50.0			63.6
腋窝淋巴结转移度
	≤20%	21	83.6	0.421	0.516	89.5	4.708	0.030	78.3	4.628	0.031	80.0	1.669	0.196
	>20%	47	77.1	0.421	0.516	56.0	4.708	0.030	46.7	4.628	0.031	58.3	1.669	0.196
ER/PR状态
	阳性	43	82.9	1.708	0.191	75.7	6.888	0.009	64.7	6.083	0.014	72.1	3.214	0.073
	阴性	25	72.4	1.708	0.191	47.9	6.888	0.009	39.9	6.083	0.014	52.0	3.214	0.073
HER-2状态
	阳性	33	72.9	0.934	0.334	56.7	0.686	0.407	41.0	3.505	0.061	51.5	2.743	0.098
	阴性	35	84.8	0.934	0.334	73.1	0.686	0.407	70.1	3.505	0.061	77.1	2.743	0.098
Ki-67
	≤30%	38	94.4	10.910	0.001	75.3	2.467	0.116	70.1	5.254	0.022	68.4	2.462	0.117
	>30%	30	59.8	10.910	0.001	53.6	2.467	0.116	38.1	5.254	0.022	60.0	2.462	0.117
是否靶向治疗
	是	6	50.0	3.449	0.063	100.0	3.156	0.076	50.0	0.004	0.952	66.7	0.374	0.541
	否	62	82.3	3.449	0.063	62.5	3.156	0.076	56.4	0.004	0.952	64.5	0.374	0.541
辅助内分泌治疗
	是	43	82.9	1.708	0.191	75.7	6.888	0.009	64.7	6.083	0.014	72.1	3.214	0.073
	否	25	72.4	1.708	0.191	47.9	6.888	0.009	39.9	6.083	0.014	52.0	3.214	0.073
新辅助化疗
	有	63	77.3	1.273	0.259	64.5	0.640	0.424	53.8	1.249	0.264	61.9	2.887	0.089
	无	5	100.0	1.273	0.259	80.0	0.640	0.424	80.0	1.249	0.264	100.0	2.887	0.089
锁骨上区放射治疗剂量
	50 Gy	49	81.3	1.162	0.281	66.4	0.279	0.597	52.8	0.130	0.718	63.3	0.263	0.608
	>50 Gy	19	73.3	1.162	0.281	63.2	0.279	0.597	63.2	0.130	0.718	68.4	0.263	0.608

临床特征		例数	5年LRFS率(%)	χ²值	P值	5年DMFS率(%)	χ²值	P值	5年PFS率(%)	χ²值	P值	5年OS率(%)	χ²值	P值
初诊年龄
	≤50岁	41	79.1	0.005	0.944	76.7	5.818	0.016	64.5	3.773	0.052	70.7	2.051	0.152
	>50岁	27	80.0	0.005	0.944	48.6	5.818	0.016	42.4	3.773	0.052	55.6	2.051	0.152
是否绝经
	未绝经	40	78.6	0.011	0.918	70.8	1.081	0.299	61.0	0.998	0.318	70.0	0.367	0.545
	绝经	28	80.6	0.011	0.918	58.5	1.081	0.299	48.9	0.998	0.318	57.1	0.367	0.545
原发部位
	左乳	45	81.0	0.037	0.847	61.0	0.098	0.754	52.3	0.058	0.810	64.4	0.000	0.986
	右乳	23	76.3	0.037	0.847	74.9	0.098	0.754	62.5	0.058	0.810	65.2	0.000	0.986
原发肿瘤象限
	外	32	75.7	1.344	0.719	69.1	1.235	0.745	62.9	2.190	0.534	59.4	1.129	0.770
	内	4	75.0			100.0			75.0			75.0
	中央	28	80.7			56.9			42.9			64.3
	其他	4	100.0			75.0			75.0			100.0
临床肿瘤长径
	≤2 cm	10	100.0	3.011	0.222	80.0	1.135	0.567	80.0	2.446	0.294	90.0	3.822	0.148
	>2~5 cm	42	77.5			65.0			53.3			64.3
	>5 cm	16	68.8			57.3			46.9			50.0
肿瘤侵及皮肤或胸肌
	是	13	63.3	2.935	0.087	49.4	1.801	0.180	33.8	4.337	0.037	53.8	0.665	0.415
	否	55	82.5	2.935		69.4	1.801	0.180	60.7	4.337	0.037	67.3	0.665	0.415
	T分期
	T_1~2	44	83.9	1.604	0.205	72.2	0.891	0.345	63.3	1.771	0.183	70.5	1.598	0.206
	T_3~4	24	69.0	1.604	0.205	53.3	0.891	0.345	41.4	1.771	0.183	54.2	1.598	0.206
内乳淋巴结
	阳性	16	66.7	1.502	0.220	71.8	0.021	0.885	55.6	0.119	0.730	50.0	0.354	0.552
	阴性	52	83.4	1.502	0.220	63.6	0.021	0.885	55.8	0.119	0.730	69.2	0.354	0.552
锁骨上淋巴结诊断手段
	影像	22	84.2	0.779	0.377	65.5	0.495	0.482	57.3	0.596	0.440	63.6	0.097	0.755
	病理	46	76.7	0.779	0.377	65.9	0.495	0.482	55.2	0.596	0.440	65.2	0.097	0.755
锁骨上淋巴结化疗后是否CR
	是	28	88.5	2.231	0.135	85.1	6.374	0.012	78.0	8.363	0.004	82.1	7.368	0.007
	否	40	72.1	2.231	0.135	51.8	6.374	0.012	40.0	8.363	0.004	52.5	7.368	0.007
锁骨上淋巴结清扫数目
	<10枚	31	84.9	1.412	0.235	71.5	2.391	0.122	65.2	3.860	0.049	64.5	0.134	0.715
	≥10枚	37	74.6	1.412	0.235	61.5	2.391	0.122	48.6	3.860	0.049	64.9	0.134	0.715
锁骨上淋巴结转移数目
	<2枚	33	86.5	2.416	0.120	83.7	8.953	0.003	77.8	12.966	<0.001	72.7	3.268	0.071
	≥2枚	35	72.5	2.416	0.120	49.0	8.953	0.003	35.4	12.966	<0.001	57.1	3.268	0.071
锁骨上淋巴结转移度
	≤20%	33	83.5	0.981	0.322	83.7	6.518	0.011	74.9	8.046	0.005	72.7	3.495	0.062
	>20%	35	75.4	0.981	0.322	48.5	6.518	0.011	37.5	8.046	0.005	57.1	3.495	0.062
病理组织学分级
	2级	42	85.3	1.796	0.180	75.8	3.753	0.053	68.5	5.596	0.018	71.4	5.876	0.015
	3级	26	67.2	1.796	0.180	48.3	3.753	0.053	34.3	5.596	0.018	53.8	5.876	0.015
脉管瘤栓
	有	20	64.8	2.764	0.096	56.6	0.889	0.346	43.3	2.254	0.133	45.0	2.698	0.100
	无	48	84.6	2.764	0.096	69.2	0.889	0.346	61.0	2.254	0.133	72.9	2.698	0.100
腋窝淋巴结转移数目
	0枚	9	100.0	4.086	0.252	88.9	4.059	0.255	88.9	5.274	0.153	100.0	5.232	0.156
	1~3枚	12	61.4			81.8			61.4			58.3
	4~9枚	14	75.5			53.6			42.9			50.0
	≥10枚	33	80.0			58.7			50.0			63.6
腋窝淋巴结转移度
	≤20%	21	83.6	0.421	0.516	89.5	4.708	0.030	78.3	4.628	0.031	80.0	1.669	0.196
	>20%	47	77.1	0.421	0.516	56.0	4.708	0.030	46.7	4.628	0.031	58.3	1.669	0.196
ER/PR状态
	阳性	43	82.9	1.708	0.191	75.7	6.888	0.009	64.7	6.083	0.014	72.1	3.214	0.073
	阴性	25	72.4	1.708	0.191	47.9	6.888	0.009	39.9	6.083	0.014	52.0	3.214	0.073
HER-2状态
	阳性	33	72.9	0.934	0.334	56.7	0.686	0.407	41.0	3.505	0.061	51.5	2.743	0.098
	阴性	35	84.8	0.934	0.334	73.1	0.686	0.407	70.1	3.505	0.061	77.1	2.743	0.098
Ki-67
	≤30%	38	94.4	10.910	0.001	75.3	2.467	0.116	70.1	5.254	0.022	68.4	2.462	0.117
	>30%	30	59.8	10.910	0.001	53.6	2.467	0.116	38.1	5.254	0.022	60.0	2.462	0.117
是否靶向治疗
	是	6	50.0	3.449	0.063	100.0	3.156	0.076	50.0	0.004	0.952	66.7	0.374	0.541
	否	62	82.3	3.449	0.063	62.5	3.156	0.076	56.4	0.004	0.952	64.5	0.374	0.541
辅助内分泌治疗
	是	43	82.9	1.708	0.191	75.7	6.888	0.009	64.7	6.083	0.014	72.1	3.214	0.073
	否	25	72.4	1.708	0.191	47.9	6.888	0.009	39.9	6.083	0.014	52.0	3.214	0.073
新辅助化疗
	有	63	77.3	1.273	0.259	64.5	0.640	0.424	53.8	1.249	0.264	61.9	2.887	0.089
	无	5	100.0	1.273	0.259	80.0	0.640	0.424	80.0	1.249	0.264	100.0	2.887	0.089
锁骨上区放射治疗剂量
	50 Gy	49	81.3	1.162	0.281	66.4	0.279	0.597	52.8	0.130	0.718	63.3	0.263	0.608
	>50 Gy	19	73.3	1.162	0.281	63.2	0.279	0.597	63.2	0.130	0.718	68.4	0.263	0.608

因素			HR值	95%CI	P值
无远处转移生存
	腋窝淋巴结转移数目
		0枚	1.000
		1~3枚	3.347	0.343~32.610	0.298
		4~9枚	6.260	0.887~44.190	0.066
		≥10枚	8.151	1.011~65.726	0.049
无进展生存
	Ki-67

		≤30%	1.000
		>30%	6.674
			2.291~19.443	0.001
	锁骨上淋巴结清扫数目
		<10枚	1.000
		≥10枚	2.605	1.039~6.528	0.041
	锁骨上淋巴结转移数目
		<2枚	1.000
		≥2枚	2.958	1.155~7.577	0.024

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