Coriddi Michelle, Khansa Ibrahim, Stephens Julie, Miller Michael, Boehmler James, Tiwari Pankaj
From the *Department of Plastic Surgery, Ohio State University Wexner Medical Center; and †Center for Biostatistics, Ohio State University Wexner Medical Center, Columbus, OH.
Ann Plast Surg. 2015 Jan;74(1):22-5. doi: 10.1097/SAP.0b013e31828d7285.
Upper extremity lymphedema is a well-described complication of breast cancer treatment. Risk factors for lymphedema development include axillary lymph node dissection (ALND), obesity, increasing age, radiation, and postoperative complications. In this study, we seek to evaluate a cohort of patients who have either self-referred or been referred to the Department of Physical Therapy for lymphedema treatment. Our goal is to evaluate specific risk factors associated with the severity of lymphedema in this patient population.
All patients who presented to the Wexner Medical Center at the Ohio State University between January 1, 2009, and December 31, 2010, with a chief complaint of upper extremity lymphedema after breast cancer treatment were reviewed retrospectively. Upper extremity lymphedema index (UELI) was used as a severity indicator and patient factors including demographics and breast cancer treatments were evaluated. Univariate and multivariate statistical analyses were performed.
Fifty (4.5%) patients presented for upper extremity lymphedema treatment after breast cancer treatment (total of 1106 patients treated surgically for breast cancer). Greater UELIs were found in patients 50 years and older, those with ALND, radiation, chemotherapy, pathologic stage greater than 3, and an International Society of Lymphology lymphedema stage II (P < 0.05). The multivariate model showed age older than 50 years and pathologic stage greater than 3 were significant predictors of higher UELI (P < 0.05).
In this study, we report that in patients who present for lymphedema treatment, increased UELI is significantly related to ALND, radiation therapy, chemotherapy, age, and pathologic stage. An improved understanding of the patient population referred for lymphedema treatment will allow for the identification of patients who may be candidates for therapeutic intervention.
上肢淋巴水肿是乳腺癌治疗中一种广为人知的并发症。淋巴水肿发生的风险因素包括腋窝淋巴结清扫术（ALND）、肥胖、年龄增长、放疗以及术后并发症。在本研究中，我们旨在评估一组自行前来或被转介至物理治疗科进行淋巴水肿治疗的患者。我们的目标是评估该患者群体中与淋巴水肿严重程度相关的特定风险因素。
对2009年1月1日至2010年12月31日期间因乳腺癌治疗后出现上肢淋巴水肿为主诉而就诊于俄亥俄州立大学韦克斯纳医学中心的所有患者进行回顾性分析。采用上肢淋巴水肿指数（UELI）作为严重程度指标，并评估患者的因素，包括人口统计学特征和乳腺癌治疗情况。进行单因素和多因素统计分析。
50名（4.5%）患者在乳腺癌治疗后前来接受上肢淋巴水肿治疗（共有1106名患者接受了乳腺癌手术治疗）。在50岁及以上的患者、接受腋窝淋巴结清扫术、放疗、化疗、病理分期大于3期以及国际淋巴学会淋巴水肿II期的患者中发现了更高的上肢淋巴水肿指数（P < 0.05）。多因素模型显示，年龄大于50岁和病理分期大于3期是上肢淋巴水肿指数升高的显著预测因素（P < 0.05）。
在本研究中，我们报告称，在前来接受淋巴水肿治疗的患者中，上肢淋巴水肿指数升高与腋窝淋巴结清扫术、放射治疗、化疗、年龄和病理分期显著相关。对前来接受淋巴水肿治疗的患者群体有更深入的了解将有助于识别可能适合进行治疗干预的患者。
