School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
Lancet Oncol. 2013 May;14(6):500-15. doi: 10.1016/S1470-2045(13)70076-7. Epub 2013 Mar 27.
The body of evidence related to breast-cancer-related lymphoedema incidence and risk factors has substantially grown and improved in quality over the past decade. We assessed the incidence of unilateral arm lymphoedema after breast cancer and explored the evidence available for lymphoedema risk factors.
We searched Academic Search Elite, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials (clinical trials), and Medline for research articles that assessed the incidence or prevalence of, or risk factors for, arm lymphoedema after breast cancer, published between Jan 1, 2000, and June 30, 2012. We extracted incidence data and calculated corresponding exact binomial 95% CIs. We used random effects models to calculate a pooled overall estimate of lymphoedema incidence, with subgroup analyses to assess the effect of different study designs, countries of study origin, diagnostic methods, time since diagnosis, and extent of axillary surgery. We assessed risk factors and collated them into four levels of evidence, depending on consistency of findings and quality and quantity of studies contributing to findings.
72 studies met the inclusion criteria for the assessment of lymphoedema incidence, giving a pooled estimate of 16.6% (95% CI 13.6-20.2). Our estimate was 21.4% (14.9-29.8) when restricted to data from prospective cohort studies (30 studies). The incidence of arm lymphoedema seemed to increase up to 2 years after diagnosis or surgery of breast cancer (24 studies with time since diagnosis or surgery of 12 to <24 months; 18.9%, 14.2-24.7), was highest when assessed by more than one diagnostic method (nine studies; 28.2%, 11.8-53.5), and was about four times higher in women who had an axillary-lymph-node dissection (18 studies; 19.9%, 13.5-28.2) than it was in those who had sentinel-node biopsy (18 studies; 5.6%, 6.1-7.9). 29 studies met the inclusion criteria for the assessment of risk factors. Risk factors that had a strong level of evidence were extensive surgery (ie, axillary-lymph-node dissection, greater number of lymph nodes dissected, mastectomy) and being overweight or obese.
Our findings suggest that more than one in five women who survive breast cancer will develop arm lymphoedema. A clear need exists for improved understanding of contributing risk factors, as well as of prevention and management strategies to reduce the individual and public health burden of this disabling and distressing disorder.
The National Breast Cancer Foundation, Australia.
过去十年中，有关乳腺癌相关淋巴水肿发病率和危险因素的证据大量增加并得到改善。我们评估了乳腺癌后单侧手臂淋巴水肿的发病率，并探讨了淋巴水肿危险因素的现有证据。
我们在 Academic Search Elite、Cumulative Index to Nursing and Allied Health、Cochrane Central Register of Controlled Trials（临床试验）和 Medline 中搜索了评估乳腺癌后手臂淋巴水肿发病率或患病率或危险因素的研究文章，这些文章的发表时间为 2000 年 1 月 1 日至 2012 年 6 月 30 日。我们提取了发病率数据并计算了相应的精确二项式 95%置信区间。我们使用随机效应模型计算了淋巴水肿发病率的汇总总体估计值，并进行了亚组分析，以评估不同研究设计、研究来源国家、诊断方法、诊断后时间和腋窝手术范围的影响。我们评估了危险因素，并根据研究结果的一致性和研究结果的质量和数量将其整理为四个证据水平。
72 项研究符合评估淋巴水肿发病率的纳入标准，汇总估计值为 16.6%（95%CI 13.6-20.2）。当仅限于前瞻性队列研究的数据时，我们的估计值为 21.4%（14.9-29.8）（30 项研究）。手臂淋巴水肿的发病率似乎在乳腺癌诊断或手术后 2 年内增加（12-<24 个月的诊断或手术时间的 24 项研究；18.9%，14.2-24.7），当使用多种诊断方法评估时发病率最高（9 项研究；28.2%，11.8-53.5），接受腋窝淋巴结清扫术的女性发病率比接受前哨淋巴结活检术的女性高约四倍（18 项研究；19.9%，13.5-28.2）（18 项研究；5.6%，6.1-7.9）。有 29 项研究符合评估危险因素的纳入标准。具有较强证据水平的危险因素包括广泛的手术（即腋窝淋巴结清扫术、切除的淋巴结数量更多、乳房切除术）和超重或肥胖。
我们的研究结果表明，超过五分之一的乳腺癌幸存者会出现手臂淋巴水肿。显然，需要更好地了解致病危险因素，以及预防和管理策略，以降低这种使人丧失能力和痛苦的疾病对个人和公共健康的负担。
澳大利亚国家乳腺癌基金会。
