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.
背景/目的：乳腺癌同侧锁骨上淋巴结同步转移（sISLMs）较为罕见且预后不良。最佳的区域治疗策略尚未明确，尤其是锁骨上淋巴结清扫术（SLND）的作用。方法：我们进行了系统综述和网状荟萃分析，纳入截至2023年12月底发表的研究，以放疗联合全身治疗（RT+ST）为参照，比较SLND联合放疗及全身治疗（SLND+RT+ST）、SLND联合全身治疗（SLND+ST）以及单纯全身治疗（ST）的疗效。结果：共纳入10项研究（3346例患者）进行总生存期（OS）分析，6项研究进行无病生存期（DFS）分析。与RT+ST相比，SLND+RT+ST在OS和DFS方面表现相似。敏感性分析显示，仅清扫V区淋巴结可改善OS（风险比：0.47，95%置信区间：0.29–0.77），而更广泛的清扫（V区及以上）则导致预后恶化（风险比：1.41，95%置信区间：1.10–1.80）。结论：这些结果表明选择性SLND可能使部分患者获益，但在未来随机试验结果公布前，应谨慎考虑其更广泛的应用。
肿瘤(癌症)患者之家