Kasse A A, Diop M, Dieng M, Deme A, Ndaw D, Fall M G, Diop P S, Betel E, Dembele B, Drabo B, Timbely G, Toure P
Institut Ouest Africain de Lutte Contre le Cancer Université Cheikh Anta DIOP, Dakar FANN Sénégal.
Dakar Med. 1999;44(1):32-5.
Postmastectomy lymphedema of the arm is frequently associated to different factors including axillary node involvement and local and regional treatment of breast cancer. Our aims was to identify risk factors of postmastectomy lymphedema. From a retrospective analysis of 735 breast cancers treated in our institute, we found 61 lymphedema of the arm. We then describe our study population and identify by univariate et multivariate analysis the factors significantly associated to the disease. The majority of the patients were young black African female found to have locally advanced breast cancers (88% of T3 et T4 UICC 1988), inflammatory diseases (46% of PEV 2 and 3 of Gustave ROUSSY Institute classification of inflammatory breast cancers). Ulceration is found in half of the patients, metastasis in 20%. The patients first underwent chemotherapy mainly with cyclophosphamide alone (56%). Only 59 patients (8%) had preoperative radiation. Surgery consisted mainly in modified radical mastectomy and lymph node dissection (95%). Residual disease is left in 50% of the cases. Only 35% had post-operative chemotherapy and 9% postoperative external beam radiation therapy. From that population, during the follow up, 61 patients were found to have postmastectomy lymphedema. The disease was asymptomatic in 60% of the cases and painful in 26%. 30% of all the patients spontaneously partially regressed. From univariate analysis we found 7 factors associated with lymphedema: The big size of the tumor (p = 0.005), clinically involved axillary lymph nodes (p = 0.001), metastatic disease (p = 0.0046), traditional or inadequate surgery out of the Institute (p = 0.001), lack of post-operative chemotherapy (p = 0.002), postoperative external beam radiations (p = 0.005), relapse (p = 0.002). From logistic regression analysis three independent factors were found: clinically involved axillary lymph nodes (p = 0.0267), metastasis (p = 0.0002) and local or regional relapse (p = 0.0405). In our practice we found that advanced disease, treated by traditional healers or surgery nurses who had relapsed after mastectomy and external beam radiations without chemotherapy have higher risks of lymphedema.
手臂的乳房切除术后淋巴水肿常与多种因素相关，包括腋窝淋巴结受累以及乳腺癌的局部和区域治疗。我们的目的是确定乳房切除术后淋巴水肿的危险因素。通过对我院治疗的735例乳腺癌患者进行回顾性分析，我们发现61例手臂淋巴水肿。然后我们描述了研究人群，并通过单因素和多因素分析确定了与该疾病显著相关的因素。大多数患者是年轻的非洲黑人女性，患有局部晚期乳腺癌（88%为1988年UICC T3和T4期）、炎症性疾病（46%为古斯塔夫·鲁西研究所炎症性乳腺癌分类中的PEV 2和3级）。一半的患者有溃疡，20%有转移。患者首先主要接受单独使用环磷酰胺的化疗（56%）。只有59例患者（8%）接受了术前放疗。手术主要包括改良根治性乳房切除术和淋巴结清扫术（95%）。50%的病例有残留病灶。只有35%的患者接受了术后化疗，9%接受了术后体外放疗。在该人群的随访中，发现61例患者有乳房切除术后淋巴水肿。该疾病在60%的病例中无症状，26%有疼痛。所有患者中有30%自发部分消退。通过单因素分析，我们发现7个与淋巴水肿相关的因素：肿瘤体积大（p = 0.005）、临床腋窝淋巴结受累（p = 0.001）、转移性疾病（p = 0.0046）、研究所外传统或不充分的手术（p = 0.001）、缺乏术后化疗（p = 0.002）、术后体外放疗（p = 0.005）、复发（p = 0.002）。通过逻辑回归分析发现了三个独立因素：临床腋窝淋巴结受累（p = 0.0267）、转移（p = 0.0002）和局部或区域复发（p = 0.0405）。在我们的实践中，我们发现晚期疾病，由传统治疗师或手术护士治疗，乳房切除术后复发且未进行化疗仅接受体外放疗的患者发生淋巴水肿的风险更高。
