Department of Health Science, Lund University, S-221 00 Lund, Sweden.
Acta Oncol. 2010;49(2):166-73. doi: 10.3109/02841860903483676.
Arm lymphoedema is a frequent complication after breast cancer treatment. Early diagnosis and treatment is considered important for successful management of breast cancer related arm lymphoedema (BCRL). The purpose was to identify BCRL incidence, time of onset, progression/regression and associated factors 10 years after breast cancer diagnosis.
Two hundred and ninety two patients treated with axillary node dissection and radiotherapy were included in this retrospective study. A total of 111 diagnosed with BCRL (incidence 38.7%). Of these women 98 were followed for up to 10 years after BCRL diagnosis. Forty consecutive patients registered with no BCRL were included in the control group. BCRL was defined as an increase in arm volume difference >or=5% and an increased thickness of subcutis. Follow-up was performed twice a year, including assessment of lymphoedema relative volume (LRV) by water displacement method and compression treatment. Additional intensive treatment was given if LRV increased by more than 5% since the previous visit or exceeded 20% in total.
Mean LRV was 8.1 +/-3.6% at diagnosis and 9.0+/-6.7% at last follow-up measurement (mean 48.9+/-39.2 months) with no significant difference. There was no difference in progression of LRV between groups with early versus late diagnosis (within or after 12 months postoperatively), small (5-<10%) versus large (>or=10%) LRV at time of diagnosis, or regular (at least twice a year) versus non-regular treatment. More BCRL patients with large LRV at diagnosis (15.8%), exceeded LRV >or=20% during follow-up time, than patients with small LRV at diagnosis (10.1%).
BCRL can be identified at an early stage both in regard to time of diagnosis after operation and to edema volume, and that edema volume can be kept at a low level for at least 10 years. Small LRV at time of diagnosis appears to be more important for minimizing the progression of LRV than time of diagnosis after operation.
手臂淋巴水肿是乳腺癌治疗后的常见并发症。早期诊断和治疗被认为是成功管理乳腺癌相关手臂淋巴水肿（BCRL）的重要因素。本研究的目的是确定乳腺癌诊断后 10 年内 BCRL 的发病率、发病时间、进展/消退情况以及相关因素。
本回顾性研究纳入了 292 例接受腋窝淋巴结清扫和放疗的患者。共有 111 例被诊断为 BCRL（发病率为 38.7%）。其中 98 例在 BCRL 诊断后随访长达 10 年。40 例连续登记且无 BCRL 的患者被纳入对照组。BCRL 定义为手臂体积差异增加≥5%和皮下组织厚度增加。随访每两年进行一次，包括用水置换法评估淋巴水肿相对体积（LRV）和压缩治疗。如果与上次就诊相比 LRV 增加超过 5%或总增加超过 20%，则给予额外的强化治疗。
诊断时的平均 LRV 为 8.1±3.6%，最后一次随访测量时为 9.0±6.7%（平均 48.9±39.2 个月），无显著差异。早期（术后 12 个月内）与晚期（术后 12 个月后）诊断、早期诊断时小（5-<10%）与大（≥10%）LRV、规律（至少每年两次）与非规律治疗之间，LRV 进展无差异。诊断时 LRV 较大（15.8%）的 BCRL 患者，在随访期间 LRV 超过≥20%的比例高于诊断时 LRV 较小（10.1%）的患者。
BCRL 无论是在手术后的诊断时间还是在水肿体积方面，都可以在早期被识别，并且至少在 10 年内可以将水肿体积保持在较低水平。诊断时的小 LRV 似乎比手术后的诊断时间更能减少 LRV 的进展。
