Monleon Sandra, Murta-Nascimento Cristiane, Bascuas Iria, Macià Francesc, Duarte Esther, Belmonte Roser
1 Servei de Medicina Física i Rehabilitació, e Hospital Mar-Esperança Parc de Salut Mar , Barcelona, Spain .
2 Departament de Medicina, Universitat Autònoma de Barcelona . Cerdanyola Del Valles, Barcelona, Spain .
Lymphat Res Biol. 2015 Dec;13(4):268-74. doi: 10.1089/lrb.2013.0042. Epub 2014 May 16.
Factors associated with lymphedema development after breast cancer surgery are not well established. The purpose is to assess the value of patient, disease and treatment-related factors predicting lymphedema development.
This study included 371 women with primary invasive breast cancer treated surgically between 2005 and 2009 with follow-up until December 2011. At each follow-up visit, both upper limb circumferences were measured at seven points to calculate the upper limb volume. Kaplan-Meier and Cox regression models for survival were applied. By the end of the follow-up period, 33.4% of women (n=124) had developed lymphedema. According to volume, lymphedema at diagnosis was mild in 78.5%, moderate in 19.0%, and severe in 2.5% of them. A 77.4% of lymphedema had enough clinical relevance to be treated. The probability of developing lymphedema within 12, 24, and 36 months post-surgery was 28.7% (95%CI 24.1-34.0%), 34.6% (95%CI 29.5-40.2%), and 38.3% (95%CI 32.8-44.3%), respectively. High stages, axillary lymph node dissection, chemotherapy, radiotherapy, and postoperative seroma were predictors of lymphedema in the bivariate survival analysis. Only axillary lymph node dissection and radiotherapy maintained their significance in the multivariate model. When the analysis was restricted to patients who underwent axillary lymph node dissection, the number of nodes excised did not influence the occurrence of lymphedema.
Axillary lymph node dissection and radiotherapy affected lymphedema development. This study provides support that breast cancer patients with such characteristics should be closely monitored, especially during the first year after surgery.
乳腺癌手术后发生淋巴水肿的相关因素尚未完全明确。目的是评估患者、疾病及治疗相关因素对预测淋巴水肿发生的价值。
本研究纳入了2005年至2009年间接受手术治疗的371例原发性浸润性乳腺癌女性患者，随访至2011年12月。每次随访时，测量双侧上肢七个部位的周长以计算上肢体积。应用Kaplan-Meier生存曲线和Cox回归模型。随访期末，33.4%的女性（n = 124）发生了淋巴水肿。根据体积，诊断时78.5%的淋巴水肿为轻度，19.0%为中度，2.5%为重度。77.4%的淋巴水肿具有足够的临床相关性需要治疗。术后12、24和36个月发生淋巴水肿的概率分别为28.7%（95%CI 24.1 - 34.0%）、34.6%（95%CI 29.5 - 40.2%）和38.3%（95%CI 32.8 - 44.3%）。在单变量生存分析中，高分期、腋窝淋巴结清扫、化疗、放疗及术后血清肿是淋巴水肿的预测因素。在多变量模型中，只有腋窝淋巴结清扫和放疗仍具有显著意义。当分析仅限于接受腋窝淋巴结清扫的患者时，切除的淋巴结数量不影响淋巴水肿的发生。
腋窝淋巴结清扫和放疗影响淋巴水肿的发生。本研究支持对具有这些特征的乳腺癌患者应密切监测，尤其是在术后第一年。
