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Review
. 2025 Jun 21;17(13):2081.
doi: 10.3390/cancers17132081.

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

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 , Serene Si Ning Goh  1   2   4
Affiliations
Review

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

George Shiyao He et al. Cancers (Basel). .

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.

Keywords: breast cancer; disease-free survival; locoregional therapy; network meta-analysis; overall survival; supraclavicular lymph node dissection; supraclavicular lymph node metastases.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart showing the study selection process.
Figure 2
Figure 2
Forrest plot comparing OS across SLND + RT + ST vs. SLND + ST vs. ST alone with RT + ST as reference group.
Figure 3
Figure 3
Forrest plot comparing DFS between SLND + RT + ST vs. RT + ST.
Figure 4
Figure 4
Forrest plot comparing OS between SLND (level V-only) + RT + ST vs. RT + ST.
Figure 5
Figure 5
Forest plot comparing OS across extended neck dissection + RT + ST vs. SLND + ST vs. ST alone with RT + ST as reference group.
Figure 6
Figure 6
Sensitivity analysis stratified by RT dose, evaluating OS across treatment modalities with RT + ST as the reference.
Figure 7
Figure 7
Summary of risk of bias of reviewed studies.
See this image and copyright information in PMC

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