Hayes Sandra C, Janda Monika, Cornish Bruce, Battistutta Diana, Newman Beth
Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
J Clin Oncol. 2008 Jul 20;26(21):3536-42. doi: 10.1200/JCO.2007.14.4899.
Secondary lymphedema is associated with adverse physical and psychosocial consequences among women with breast cancer (BC). This article describes the prevalence and incidence of lymphedema between 6 and 18 months after BC treatment; personal, treatment, and behavioral correlates of lymphedema status; and the presence of other upper-body symptoms (UBS) and function (UBF).
A population-based sample of Australian women (n = 287) with recently diagnosed, invasive BC were evaluated on five occasions using bioimpedance spectroscopy. Lymphedema was diagnosed when the ratio of impedance values, comparing treated and untreated sides, was three standard deviations more than normative data. UBF was assessed using the validated Disability of the Arm, Shoulder, and Hand questionnaire.
From 6 to 18 months after surgery, 33% (n = 62) of the sample were classified as having lymphedema; of these, 40% had long-term lymphedema. Although older age, more extensive surgery or axillary node dissection, and experiencing one or more treatment-related complication(s) or symptom(s) at baseline were associated with increased odds, lower socioeconomic status, having a partner, greater child care responsibilities, being treated on the dominant side, participation in regular activity, and having good UBF were associated with decreased odds of lymphedema. Not surprisingly, lymphedema leads to reduced UBF; however, BC survivors report high prevalences of other UBS (34% to 62%), irrespective of their lymphedema status.
Lymphedema is a public health issue deserving greater attention. More systematic surveillance for earlier detection and the potential benefits of physical activity to prevent lymphedema and mitigate symptoms warrant further clinical integration and research.
继发性淋巴水肿与乳腺癌（BC）女性患者的不良身体和心理社会后果相关。本文描述了BC治疗后6至18个月期间淋巴水肿的患病率和发病率；淋巴水肿状态的个人、治疗和行为相关因素；以及其他上身症状（UBS）和功能（UBF）的存在情况。
对澳大利亚287名近期诊断为浸润性BC的女性进行基于人群的抽样，使用生物电阻抗光谱法进行了五次评估。当比较患侧和未患侧的阻抗值之比比正常数据高出三个标准差时，诊断为淋巴水肿。使用经过验证的手臂、肩部和手部残疾问卷评估UBF。
术后6至18个月，33%（n = 62）的样本被归类为患有淋巴水肿；其中，40%患有长期淋巴水肿。虽然年龄较大、手术范围更广或腋窝淋巴结清扫、以及在基线时经历一种或多种与治疗相关的并发症或症状与淋巴水肿几率增加相关，但社会经济地位较低、有伴侣、育儿责任更大、在优势侧接受治疗、参与定期活动以及UBF良好与淋巴水肿几率降低相关。不出所料，淋巴水肿会导致UBF降低；然而，BC幸存者报告其他UBS的患病率很高（34%至62%），无论其淋巴水肿状态如何。
淋巴水肿是一个值得更多关注的公共卫生问题。更系统的监测以早期发现以及体育活动对预防淋巴水肿和减轻症状的潜在益处值得进一步的临床整合和研究。
