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Treatment Patterns and Outcomes of Women with Breast Cancer and Supraclavicular Nodal Metastases

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In 2002, breast cancer patients with supraclavicular nodal metastases (cN3c) were downstaged from AJCC stage IV to IIIc, prompting management with locoregional treatment. We sought to estimate the impact of multimodal therapy on overall survival (OS) in a contemporary cohort of cN3c patients.

Methods

Women ≥ 18 years with cT1-T4c/cN3c invasive breast cancer who underwent systemic therapy were identified from the 2004–2016 National Cancer Database. We compared three patient cohorts: (a) cN3c + multimodal therapy (systemic therapy, surgery, and radiation); (b) cN3c + non-standard therapy; and, (c) cM1. Logistic regression identified factors associated with receipt of multimodal therapy and Kaplan–Meier was used to estimate unadjusted OS. The Cox proportional hazards model estimated effects of diagnosis and treatment on OS after adjustment.

Results

Overall, 1827 (3.7%) patients with cN3c disease and 46,919 (96.3%) cM1 patients were identified. Of cN3c patients, 74.5% (n = 1362) received multimodal therapy and 25.5% (n = 465) received non-standard therapy; receipt of multimodal therapy was associated with improved 5-year OS (multimodal: 59% vs. M1: 28% vs. non-standard: 28%, log-rank p < 0.001). Adjusting for covariates, non-standard therapy was associated with an increased risk of death compared with receipt of multimodal therapy (HR 2.20, 95% CI 1.71–2.83, p < 0.001). Private insurance was the only patient characteristic associated with a greater likelihood of receiving multimodal therapy (OR 2.81; 95% CI, 1.64–4.82; p < 0.001).

Conclusion

Women with cN3c breast cancer who received multimodal therapy demonstrated improved overall survival when compared with patients undergoing non-standard therapy and those with metastatic (M1) disease. Although selection bias may contribute to worse overall survival among cN3c patients undergoing non-standard therapy, national guidelines should encourage locoregional treatment in carefully selected patients.

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Acknowledgement

Portions of this manuscript were presented at the Society of Surgical Oncology Annual Meeting on March 23, 2018. The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

Dr. O. Fayanju was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under Award Number 5KL2TR001115 (PI: Boulware). Dr. R. Greenup was supported by the NIH BIRCWH K12HD043446 (PI: Andrews). This work was also supported by the Duke Cancer Institute through NIH grant P30CA014236 (PI: Kastan). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Nina P. Tamirisa MD, MS

  2. Duke Cancer Institute, Durham, NC, USA

    Yi Ren MS, Samantha M. Thomas MS, Oluwadamilola M. Fayanju MS, MA, MPHS, Jennifer K. Plichta MD, MS, Laura H. Rosenberger MD, MS, Jeremy Force DO, Terry Hyslop PhD, E. Shelley Hwang MD, MPH & Rachel A. Greenup MD, MPH

  3. Department of Medicine, Duke University School of Medicine, Durham, NC, USA

    Brittany M. Campbell MD & Jeremy Force DO

  4. Department of Surgery, Duke University School of Medicine, Durham, NC, USA

    Oluwadamilola M. Fayanju MS, MA, MPHS, Jennifer K. Plichta MD, MS, Laura H. Rosenberger MD, MS, E. Shelley Hwang MD, MPH & Rachel A. Greenup MD, MPH

  5. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA

    Terry Hyslop PhD

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  1. Nina P. Tamirisa MD, MS
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  2. Yi Ren MS
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  5. Oluwadamilola M. Fayanju MS, MA, MPHS
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  7. Laura H. Rosenberger MD, MS
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  8. Jeremy Force DO
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  10. E. Shelley Hwang MD, MPH
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  11. Rachel A. Greenup MD, MPH
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Corresponding author

Correspondence to Rachel A. Greenup MD, MPH.

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Disclosures

Samantha Thomas - Abbvie, Inc: consulting on biosimilar and bioequivalence work unrelated to this work. Jeremy Force - Consulting: Genomic Health.

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Tamirisa, N.P., Ren, Y., Campbell, B.M. et al. Treatment Patterns and Outcomes of Women with Breast Cancer and Supraclavicular Nodal Metastases. Ann Surg Oncol 28, 2146–2154 (2021). https://doi.org/10.1245/s10434-020-09024-1

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  • DOI: https://doi.org/10.1245/s10434-020-09024-1

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