Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Breast Cancer Res Treat. 2013 May;139(1):125-34. doi: 10.1007/s10549-013-2509-y. Epub 2013 Apr 16.
Knowledge about long-term consequences of breast cancer treatment on shoulder and arm function and volume in stages I-II breast cancer survivors is limited. The effects of shoulder-arm function shortly after surgery on long-term function are unknown. One hundred and ninety-four women were examined pre-surgery (T0) and 6 weeks after surgery (T1). Of those, 110 were re-examined 7 years later (T2). Thirty-four women underwent sentinel lymph node biopsy (SLNB) and 76 underwent axillary lymph node dissection (ALND). Differences between affected and unaffected side were calculated for four ranges of motion functions, three strength functions and arm volume. These were used to analyse time and group effects. Differences exceeding 20° in range of motion, 20 % in strength and 200 ml in arm volume were considered clinically relevant. Multivariate regression analyses examined the effect of shoulder-arm function at T1 on shoulder-arm function at T2. Additional predictor variables included were age, follow-up time, Body Mass Index, complications, chemotherapy, radiation, SLNB/ALND and type of breast surgery. At T2, range of motion (except external rotation), abduction strength and arm volume were impaired compared to T0. After ALND, women had significantly more forward flexion impairment, increased arm volume and clinically relevant impairments (70 %) than after SLNB (41 %). T1 external rotation, abduction-external rotation, grip strength and arm volume were the strongest predictors of these variables at T2. Age was the strongest predictor of the remaining four variables. ALND predicted arm volume only. Seven years after breast cancer surgery, two-fifth of the women after SLNB and seven out of ten women after ALND had impairments. Impairments were found in five of eight shoulder-arm functions. After SLNB, women have less forward flexion impairment and less arm volume increase than after ALND. Shoulder-arm function at 6 weeks after surgery and age are the strongest predictors of long-term shoulder-arm function.
关于早期乳腺癌患者接受乳腺癌治疗后肩部和手臂功能及体积的长期影响的知识有限。手术后短期内肩部和手臂功能对长期功能的影响尚不清楚。194 名女性在术前（T0）和术后 6 周（T1）进行了检查。其中，110 名女性在 7 年后（T2）再次接受检查。34 名女性接受了前哨淋巴结活检（SLNB），76 名女性接受了腋窝淋巴结清扫术（ALND）。对四个运动功能范围、三个力量功能和手臂体积进行了患侧和非患侧之间的差异计算。这些用于分析时间和组间的影响。运动范围差异超过 20°、力量差异超过 20%、手臂体积差异超过 200ml 被认为具有临床意义。多元回归分析检查了 T1 时的肩部和手臂功能对 T2 时肩部和手臂功能的影响。还包括年龄、随访时间、体重指数、并发症、化疗、放疗、SLNB/ALND 和乳房手术类型等预测变量。在 T2 时，与 T0 相比，运动范围（外旋除外）、外展力量和手臂体积受损。与 SLNB（41%）相比，ALND 后女性的前屈功能障碍更明显、手臂体积更大且具有临床意义的障碍（70%）。T1 时的外旋、外展-外旋、握力和手臂体积是 T2 时这些变量的最强预测因子。年龄是其余四个变量的最强预测因子。ALND 仅预测手臂体积。乳腺癌手术后 7 年，SLNB 后五分之二的女性和 ALND 后十分之七的女性有损伤。在八项肩部和手臂功能中有五项发现了功能障碍。与 ALND 相比，SLNB 后女性的前屈功能障碍较少，手臂体积增加较少。手术后 6 周的肩部和手臂功能以及年龄是长期肩部和手臂功能的最强预测因子。
