# Supraclavicular Lymph Node Dissection in Breast Cancer with Synchronous Supraclavicular Metastases: A Systematic Review and Network Meta-Analysis

## TL;DR

This study finds that surgically removing lymph nodes above the collarbone in breast cancer patients with limited metastasis may help survival, but broader surgery worsens outcomes.

## Contribution

The study provides new evidence on the selective benefit of supraclavicular lymph node dissection in specific breast cancer cases.

## Key findings

- Selective dissection of level V lymph nodes improved overall survival.
- More extensive dissections worsened outcomes, likely due to more aggressive disease.
- Surgery combined with standard treatments did not consistently improve survival.

## Abstract

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.

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.