Rietman J S, Dijkstra P U, Geertzen J H B, Baas P, de Vries J, Dolsma W V, Groothoff J W, Eisma W H, Hoekstra H J
Department of Rehabilitation Medicine, Martini Hospital Groningen, PO Box 30033, NL-9700 RM Groningen, The Netherlands.
Ann Surg Oncol. 2004 Nov;11(11):1018-24. doi: 10.1245/ASO.2004.03.512. Epub 2004 Oct 15.
In a prospective study, upper limb morbidity and perceived disability/activities of daily life (ADLs) were assessed before and 1 year after sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND).
A total of 204 patients with stage I/II breast cancer (mean age, 55.6 years; SD, 11.6 years) entered the study, and 189 patients (93%) could be evaluated after 1 year. Fifty-eight patients (31%) underwent only SLNB, and 131 (69%) underwent ALND. Assessments performed before surgery (t(0)) and 1 year after surgery (t(1)), included pain, shoulder range of motion, muscle strength, upper arm/forearm circumference, and perceived shoulder disability/ADL.
Considerable treatment-related upper limb morbidity was observed. Significant (P < .05) changes between t(0) and t(1) were found in all assessments except strength of elbow flexors. Patients in the ALND group showed significantly more changes in the range of motion in forward flexion, abduction, and abduction/external rotation; grip strength and strength of shoulder abductors; circumference of upper arm and forearm; and perceived shoulder disability in ADLs compared with the SLNB group. Multivariate linear regression analysis showed that ALND could predict a decrease of range of motion in forward flexion, abduction, strength of shoulder abductors, grip strength, and shoulder-related ADLs and an increase in the circumference of the upper arm. Radiation of the axilla (19 patients) predicts an additional decrease in shoulder range of motion.
One year after treatment of breast cancer, there is significantly less upper limb morbidity after SLNB compared with ALND. ALND is a predictor for upper limb morbidity.
在一项前瞻性研究中，于前哨淋巴结活检（SLNB）或腋窝淋巴结清扫（ALND）术前及术后1年评估上肢发病率及感知到的残疾/日常生活活动（ADL）情况。
共有204例I/II期乳腺癌患者（平均年龄55.6岁；标准差11.6岁）进入本研究，189例患者（93%）在1年后可进行评估。58例患者（31%）仅接受了SLNB，131例患者（69%）接受了ALND。术前（t(0)）及术后1年（t(1)）进行的评估包括疼痛、肩关节活动范围、肌肉力量、上臂/前臂周长以及感知到的肩部残疾/ADL。
观察到了相当多与治疗相关的上肢发病率。除肘屈肌力量外，所有评估中t(0)与t(1)之间均发现有显著（P <.05）变化。与SLNB组相比，ALND组患者在前屈、外展及外展/外旋活动范围、握力和肩外展肌力量、上臂和前臂周长以及ADL中感知到的肩部残疾方面的变化明显更多。多因素线性回归分析显示，ALND可预测前屈、外展活动范围、肩外展肌力量、握力及与肩部相关的ADL降低以及上臂周长增加。腋窝放疗（19例患者）可预测肩关节活动范围进一步减小。
乳腺癌治疗1年后，与ALND相比，SLNB后的上肢发病率显著更低。ALND是上肢发病率的一个预测因素。
