The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification
Background: Metastasis to the infraclavicular and supraclavicular lymph nodes (ISLNs) is an important factor that predicts poor survival in patients with breast cancer; however, pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection. This stu...
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Elsevier
2025-08-01
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| Series: | Journal of the National Cancer Center |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667005425000456 |
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| author | Yanyu Chen Yuzhi Song Zhonghua Han Hui Han Tianlan Tang Silin Chen Ruizhi Zhao Cheng Huang Guiqing Shi Yuping Lin Ying Wang Liuqing Jiang Jinhua Chen Chunsen Xu Fangmeng Fu Chuan Wang Yong Yang |
| author_facet | Yanyu Chen Yuzhi Song Zhonghua Han Hui Han Tianlan Tang Silin Chen Ruizhi Zhao Cheng Huang Guiqing Shi Yuping Lin Ying Wang Liuqing Jiang Jinhua Chen Chunsen Xu Fangmeng Fu Chuan Wang Yong Yang |
| author_sort | Yanyu Chen |
| collection | DOAJ |
| description | Background: Metastasis to the infraclavicular and supraclavicular lymph nodes (ISLNs) is an important factor that predicts poor survival in patients with breast cancer; however, pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection. This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy (NAC). Methods: We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions (Fujian cohort and Hebei cohort) from 2010 to 2022. We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs. Results: There were no survival differences among patients with ISLN involvement across different assay methodologies and patient cohorts. Among 887 patients in the Fujian cohort, 238 patients (26.8 %) with positive ISLNs had significantly inferior 3-year progression-free survival (PFS, 75.9 % vs. 90.4 %, P < 0.001) and overall survival (OS, 90.6 % vs. 95.9 %, P < 0.001). After adjusting for potential confounders, ISLN involvement persisted as an independent predictor of both PFS and OS. We propose a refined axillary classification that combines pathological axillary staging post-NAC with ISLN involvement, revealing 3-year PFS rates of 95.3 %, 87.6 %, 73.4 %, and 64.5 % for the respective four groups defined by this refined classification combining axillary stage and ISLN status. Conclusions: Involvement of the ISLNs was associated with a worse prognosis, underscoring their prognostic value. This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer. |
| format | Article |
| id | doaj-art-8336ebc23d004ec58447f4beccdbf523 |
| institution | Kabale University |
| issn | 2667-0054 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the National Cancer Center |
| spelling | doaj-art-8336ebc23d004ec58447f4beccdbf5232025-08-20T03:58:18ZengElsevierJournal of the National Cancer Center2667-00542025-08-015440241310.1016/j.jncc.2025.02.005The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classificationYanyu Chen0Yuzhi Song1Zhonghua Han2Hui Han3Tianlan Tang4Silin Chen5Ruizhi Zhao6Cheng Huang7Guiqing Shi8Yuping Lin9Ying Wang10Liuqing Jiang11Jinhua Chen12Chunsen Xu13Fangmeng Fu14Chuan Wang15Yong Yang16Department of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, ChinaDepartment of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, ChinaDepartment of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaDepartment of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, ChinaFollow-Up Center, Fujian Medical University Union Hospital, Fuzhou, ChinaDepartment of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, ChinaDepartment of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, ChinaDepartment of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Corresponding authors.Department of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China; Corresponding authors.Background: Metastasis to the infraclavicular and supraclavicular lymph nodes (ISLNs) is an important factor that predicts poor survival in patients with breast cancer; however, pathological nodal staging does not traditionally include ISLNs because of their non-routine surgical dissection. This study aimed to evaluate the prognostic impact of ISLN metastasis and propose a refined nodal staging system tailored for patients undergoing neoadjuvant chemotherapy (NAC). Methods: We retrospectively reviewed 1,072 patients with breast cancer with or without ISLN metastasis who received NAC at two institutions (Fujian cohort and Hebei cohort) from 2010 to 2022. We conducted detailed survival analysis to evaluate the diagnostic consistency and prognostic significance of ISLNs. Results: There were no survival differences among patients with ISLN involvement across different assay methodologies and patient cohorts. Among 887 patients in the Fujian cohort, 238 patients (26.8 %) with positive ISLNs had significantly inferior 3-year progression-free survival (PFS, 75.9 % vs. 90.4 %, P < 0.001) and overall survival (OS, 90.6 % vs. 95.9 %, P < 0.001). After adjusting for potential confounders, ISLN involvement persisted as an independent predictor of both PFS and OS. We propose a refined axillary classification that combines pathological axillary staging post-NAC with ISLN involvement, revealing 3-year PFS rates of 95.3 %, 87.6 %, 73.4 %, and 64.5 % for the respective four groups defined by this refined classification combining axillary stage and ISLN status. Conclusions: Involvement of the ISLNs was associated with a worse prognosis, underscoring their prognostic value. This finding highlights the potential of ISLN status to influence decisions regarding adjuvant treatment in patients with breast cancer.http://www.sciencedirect.com/science/article/pii/S2667005425000456Breast cancerInfraclavicular lymph nodeSupraclavicular lymph nodeNeoadjuvant chemotherapyAxillary classification |
| spellingShingle | Yanyu Chen Yuzhi Song Zhonghua Han Hui Han Tianlan Tang Silin Chen Ruizhi Zhao Cheng Huang Guiqing Shi Yuping Lin Ying Wang Liuqing Jiang Jinhua Chen Chunsen Xu Fangmeng Fu Chuan Wang Yong Yang The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification Journal of the National Cancer Center Breast cancer Infraclavicular lymph node Supraclavicular lymph node Neoadjuvant chemotherapy Axillary classification |
| title | The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification |
| title_full | The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification |
| title_fullStr | The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification |
| title_full_unstemmed | The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification |
| title_short | The role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy: implications for regional lymph node classification |
| title_sort | role of infraclavicular and supraclavicular lymph nodes in breast cancer patients receiving neoadjuvant chemotherapy implications for regional lymph node classification |
| topic | Breast cancer Infraclavicular lymph node Supraclavicular lymph node Neoadjuvant chemotherapy Axillary classification |
| url | http://www.sciencedirect.com/science/article/pii/S2667005425000456 |
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