Johansen J, Overgaard J, Blichert-Toft M, Overgaard M
Danish Cancer Society, Department of Experimental Clinical Oncology, Aarhus.
Acta Oncol. 2000;39(3):349-54. doi: 10.1080/028418600750013122.
The purpose of this study was to determine the impact of surgery and radiotherapy on late morbidity associated with the management of the axilla in breast cancer patients. Two hundred and sixty-six patients from a randomized breast conservation trial (DBCG-82TM protocol) were called in for a single follow-up interview and clinical examination of several functional outcome measures after a median of 6.6 years (3.5-10.5). All the patients were treated with lumpectomy and axillary dissection, followed by external beam radiotherapy to the residual breast. High-risk patients were given additional radiation to the regional lymph nodes plus adjuvant systemic treatment. Twenty-eight patients (11%) had arm edema (> or = 2 cm), which was associated with the extent of axillary node dissection as well as with age and radiotherapy (relative risk, RR = 4.5 (1.8-11.2, p = 0.001)). Impaired shoulder movement of any degree (7%) was associated with radiotherapy (RR = 4.0 (1.5-13.8, p = 0.007)) and advanced age (p = 0.002), while the extent of axillary dissection as described by the number of nodes retrieved was the only factor that predicted pain on logistic regression analysis (p = 0.02). A moderate to severe change in arm/shoulder strength and working ability was observed in 7% and 5% of patients, respectively, but no independent predisposing factor was discerned for these endpoints. It is concluded that the level of late functional morbidity several years after breast-conserving treatment is relatively low and clearly relates to age, extension of surgery, irradiation of the axilla or a combination of these factors, depending on the specific clinical outcome measure.
本研究的目的是确定手术和放疗对乳腺癌患者腋窝处理相关迟发性并发症的影响。来自一项随机保乳试验（DBCG - 82TM方案）的266例患者在中位时间6.6年（3.5 - 10.5年）后被召集进行单次随访访谈以及对多项功能结局指标的临床检查。所有患者均接受了肿块切除术和腋窝淋巴结清扫术，随后对残留乳腺进行外照射放疗。高危患者接受了区域淋巴结额外放疗及辅助全身治疗。28例患者（11%）出现手臂水肿（≥2 cm），这与腋窝淋巴结清扫范围以及年龄和放疗有关（相对危险度，RR = 4.5（1.8 - 11.2，p = 0.001））。任何程度的肩部活动受限（7%）与放疗（RR = 4.0（1.5 - 13.8，p = 0.007））和高龄（p = 0.002）有关，而根据回收淋巴结数量描述的腋窝清扫范围是逻辑回归分析中预测疼痛的唯一因素（p = 0.02）。分别有7%和5%的患者观察到手臂/肩部力量和工作能力出现中度至重度变化，但未发现这些结局指标的独立诱发因素。结论是，保乳治疗数年后迟发性功能并发症水平相对较低，且明显与年龄、手术范围、腋窝放疗或这些因素的组合有关，具体取决于特定的临床结局指标。
