Kwan Marilyn L, Darbinian Jeanne, Schmitz Kathryn H, Citron Rebecca, Partee Paula, Kutner Susan E, Kushi Lawrence H
Kaiser Permanente Northern California, Oakland, 94612, USA.
Arch Surg. 2010 Nov;145(11):1055-63. doi: 10.1001/archsurg.2010.231.
To determine the incidence of breast cancer-related lymphedema (BCRL) during the early survivorship period as well as demographic, lifestyle, and clinical factors associated with BCRL development.
The Pathways Study, a prospective cohort study of breast cancer survivors with a mean follow-up time of 20.9 months.
Kaiser Permanente Northern California medical care program.
We studied 997 women diagnosed from January 9, 2006, through October 15, 2007, with primary invasive breast cancer and who were at least 21 years of age at diagnosis, had no history of any cancer, and spoke English, Spanish, Cantonese, or Mandarin.
Clinical indication for BCRL as determined from outpatient or hospitalization diagnostic codes, outpatient procedural codes, and durable medical equipment orders.
A clinical indication for BCRL was found in 133 women (13.3%), with a mean time to diagnosis of 8.3 months (range, 0.7-27.3 months). Being African American (hazard ratio, 1.93; 95% confidence interval, 1.00-3.72) or more educated (P for trend = .03) was associated with an increased risk of BCRL. Removal of at least 1 lymph node (hazard ratio, 1.04; 95% confidence interval, 1.02-1.07) was associated with an increased risk, yet no significant association was observed for type of lymph node surgery. Being obese at breast cancer diagnosis was suggestive of an elevated risk (hazard ratio, 1.43; 95% confidence interval, 0.88-2.31).
In a large cohort study, BCRL occurs among a substantial proportion of early breast cancer survivors. Our findings agree with those of previous studies on the increased risk of BCRL with removal of lymph nodes and being obese, but they point to a differential risk according to race or ethnicity.
确定乳腺癌相关淋巴水肿（BCRL）在早期生存阶段的发病率，以及与BCRL发生相关的人口统计学、生活方式和临床因素。
路径研究，一项对乳腺癌幸存者的前瞻性队列研究，平均随访时间为20.9个月。
北加利福尼亚凯撒医疗保健项目。
我们研究了997名女性，她们于2006年1月9日至2007年10月15日被诊断为原发性浸润性乳腺癌，诊断时年龄至少21岁，无任何癌症病史，且说英语、西班牙语、粤语或普通话。
根据门诊或住院诊断代码、门诊手术代码和耐用医疗设备订单确定的BCRL临床指征。
133名女性（13.3%）有BCRL临床指征，诊断的平均时间为8.3个月（范围为0.7 - 27.3个月）。非裔美国人（风险比，1.93；95%置信区间，1.00 - 3.72）或受教育程度较高（趋势P值 = 0.03）与BCRL风险增加相关。切除至少1个淋巴结（风险比，1.04；95%置信区间，1.02 - 1.07）与风险增加相关，但未观察到淋巴结手术类型与BCRL有显著关联。乳腺癌诊断时肥胖提示风险升高（风险比，1.43；95%置信区间，0.88 - 2.31）。
在一项大型队列研究中，BCRL在相当比例的早期乳腺癌幸存者中发生。我们的研究结果与先前关于切除淋巴结和肥胖会增加BCRL风险的研究一致，但指出了种族或民族之间的风险差异。
