Meeske Kathleen A, Sullivan-Halley Jane, Smith Ashley W, McTiernan Anne, Baumgartner Kathy B, Harlan Linda C, Bernstein Leslie
Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Breast Cancer Res Treat. 2009 Jan;113(2):383-91. doi: 10.1007/s10549-008-9940-5. Epub 2008 Feb 24.
Purpose Lymphedema of the arm is a potential complication of breast cancer therapy. This study examines pre-disposing factors that may operate in conjunction with treatment-related factors in the development of arm lymphedema in a large cohort of White and Black breast cancer survivors. Methods 494 women (271 White and 223 Black) with in situ to Stage III-A primary breast cancer completed a baseline interview within 18 months of diagnosis. Information on lymphedema was collected during a follow-up interview, conducted on average 50 months after diagnosis. Self-reported data were used to classify women with or without lymphedema. Multivariable logistic regression models were developed to identify risk factors for arm lymphedema. Results Arm lymphedema was associated with younger age at diagnosis (odds ratio, OR per year of age = 0.96; 95% confidence interval, CI = 0.93-0.99), positive history of hypertension (OR = 2.31; 95% CI = 1.38-3.88), obesity (OR for body mass index, BMI> or =30 = 2.48; 95% CI = 1.05-5.84) and having had surgery where 10 or more lymph nodes were excised (OR = 2.16; 95% CI = 1.12-4.17). While Black women had higher prevalence of arm lymphedema than White women (28% vs. 21%), race was not associated with lymphedema risk in models adjusted for multiple factors (adjusted OR = 1.01; 95% CI = 0.63-1.63). Conclusion Risk of arm lymphedema did not differ significantly for Black and White women. Risk factors identified in this study offer opportunities for interventions (weight loss, control of blood pressure, use of sentinel node biopsy where possible) for reducing incidence of lymphedema or controlling the symptoms associated with this condition.
目的 手臂淋巴水肿是乳腺癌治疗的一种潜在并发症。本研究调查了在一大群白人和黑人乳腺癌幸存者中，可能与治疗相关因素共同作用导致手臂淋巴水肿的 predisposing 因素。方法 494 名原位至 III - A 期原发性乳腺癌女性患者在诊断后 18 个月内完成了基线访谈。在平均诊断后 50 个月进行的随访访谈中收集了有关淋巴水肿的信息。自我报告的数据用于将女性分为有或无淋巴水肿。建立多变量逻辑回归模型以确定手臂淋巴水肿的危险因素。结果 手臂淋巴水肿与诊断时年龄较小（比值比，每年年龄的 OR = 0.96；95%置信区间，CI = 0.93 - 0.99）、高血压病史阳性（OR = 2.31；95%CI = 1.38 - 3.88）、肥胖（体重指数，BMI≥30 的 OR = 2.48；95%CI = 1.05 - 5.84）以及切除 10 个或更多淋巴结的手术史（OR = 2.16；95%CI = 1.12 - 4.17）相关。虽然黑人女性手臂淋巴水肿的患病率高于白人女性（28%对 21%），但在调整了多个因素的模型中，种族与淋巴水肿风险无关（调整后的 OR = 1.01；95%CI = 0.63 - 1.63）。结论 白人和黑人女性手臂淋巴水肿的风险没有显著差异。本研究确定的危险因素为干预措施（减肥、控制血压、尽可能使用前哨淋巴结活检）提供了机会，以降低淋巴水肿的发生率或控制与此病症相关的症状。 （注：文中“predisposing”未准确对应中文词汇，可理解为“易患的、诱发的”等意思，这里保留英文未翻译）
