The Prognostic Impact of Supraclavicular Lymph Node Metastases in Lung Cancer: Do We Need a Modification of the Current Staging System?

BACKGROUND: The management of Stage IIIB non-small-cell lung cancer (NSCLC) is complex. The current staging system does not distinguish between ipsilateral and contralateral supraclavicular lymph node involvement, although this distinction may impact prognosis. This study investigates the differences in prognosis between these two presentations of N3 disease. METHODS: This study presents a retrospective analysis of 113 patients diagnosed with Stage IIIB NSCLC who had supraclavicular lymph node metastases and underwent chemoradiation therapy. Patients were categorized based on whether their supraclavicular involvement was ipsilateral or contralateral to the primary lung tumor. Survival outcomes were calculated and correlated with various factors. RESULTS: Patients with ipsilateral supraclavicular metastases had a median progression-free survival of 12 months, compared to 9 months for those with contralateral involvement. The median overall survival for the two groups was 17 months and 14 months, respectively. Poorer survival outcomes were associated with contralateral nodal involvement, older age, poor performance status, and exclusive radiotherapy treatment. CONCLUSION: Contralateral supraclavicular metastases are associated with a worse prognosis compared to ipsilateral involvement in Stage IIIB NSCLC. These findings suggest a need to reevaluate their classification within current staging systems and to consider systemic treatment for these high-risk patients. Phase III randomized controlled trials are needed to validate this observation.