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Supraclavicular Lymph Node Dissection in Breast Cancer with Synchronous Supraclavicular Metastases: A Systematic Review and Network Meta-Analysis
by
, , and
George Shiyao He
1,†,
Jolene Li Ling Chia
1,†,
Emmeline Elaine Cua-De Los Santos
2,
Wong Hung Chew
1,
Wee Yao Koh
3,
Qin Xiang Ng
4,*
,
Samuel Ow
5 and
Serene Si Ning Goh
1,2,4,* 1
NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
2
Department of Surgery, National University Hospital, Singapore 119074, Singapore
3
Department of Radiation Oncology, National University Hospital, Singapore 119074, Singapore
4
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 119228, Singapore
5
Department of Haematology-Oncology, National University Cancer Institute, Singapore 119074, Singapore
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally and should be considered co-first authors.
Cancers 2025, 17(13), 2081; https://doi.org/10.3390/cancers17132081 (registering DOI)
Submission received: 23 May 2025
/
Revised: 12 June 2025
/
Accepted: 18 June 2025
/
Published: 21 June 2025
(This article belongs to the Special Issue Recent Advances and Challenges in Breast Cancer Surgery: 2nd Edition)
Simple Summary
Patients with breast cancer who develop spread to the lymph nodes above the collarbone—known as synchronous supraclavicular lymph node metastases—face a poor prognosis. While standard treatment typically includes radiation and chemotherapy, the benefit of surgically removing these lymph nodes remains uncertain. In this study, we reviewed existing evidence and analyzed outcomes across different treatment strategies. We found that adding surgery does not consistently improve survival outcomes. However, patients with limited disease involving only the level V lymph nodes may experience a survival benefit from selective dissection. In contrast, more extensive surgical procedures were associated with worse outcomes, likely reflecting more aggressive underlying disease. These findings suggest that surgery may be selectively beneficial in patients with limited nodal involvement and should be considered on a case-by-case basis.
Abstract
Background/Objectives: Synchronous ipsilateral supraclavicular lymph node metastases (sISLMs) in breast cancer are rare and associated with poor prognosis. The optimal locoregional treatment strategy remains unclear, particularly regarding the role of supraclavicular lymph node dissection (SLND). Methods: We conducted a systematic review and network meta-analysis, including studies published up to end December 2023, to compare the outcomes of SLND combined with radiotherapy (RT) and systemic therapy (ST), SLND with ST alone, and ST alone, using RT + ST as the reference. Results: Ten studies involving 3346 patients were included for overall survival (OS) analysis, and six studies were included for disease-free survival (DFS). SLND + RT + ST showed similar OS and DFS compared to RT + ST. Sensitivity analyses revealed that SLND limited to level V improved OS (HR: 0.47, 95% CI: 0.29–0.77), while more extensive dissections (level V+) worsened outcomes (HR: 1.41, 95% CI: 1.10–1.80). Conclusions: These findings suggest that selective SLND may benefit certain patients, but broader application should be approached with caution pending results from future randomized trials.
