Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan ; Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Departments of Physical Medicine and Rehabilitation, Chi-Mei Medical Center Liouying Campus, Tainan, Taiwan.
Ther Clin Risk Manag. 2015 Feb 27;11:349-58. doi: 10.2147/TCRM.S79118. eCollection 2015.
This retrospective cohort study evaluated whether manual lymphatic drainage (MLD) therapy increases the risk of recurrence of breast cancer.
We analyzed 1,106 women who were diagnosed with stage 0-3 breast cancer between 2007 and 2011 and experienced remission after surgery and adjuvant therapy. The patients were divided into two groups: group A (n=996), in which patients did not participate in any MLD therapy, regardless of whether they developed breast cancer-related lymphedema (BCRL) after cancer treatment; and group B (n=110), in which patients participated in MLD therapy for BCRL. All patients were monitored until October 2013 to determine whether breast cancer recurrence developed, including local or regional recurrence and distant metastasis. Patients who developed cancer recurrence prior to MLD therapy were excluded from analysis. Risk factors associated with cancer recurrence were evaluated using Cox proportional hazards models.
During the monitoring period, 166 patients (15.0%) developed cancer recurrence, including 154 (15.5%) in group A and 12 (10.9%) in group B. The median period from surgery to cancer recurrence was 1.85 (interquartile range 1.18-2.93) years. Independent risk factors for cancer recurrence were tumor histological grading of grade 3, high number (≥3) of axillary lymph node invasion, and a large tumor size (>5 cm). Factors protecting against recurrence were positive progesterone receptor status and receiving radiation therapy. Receiving MLD therapy was not an outcome factor in multivariate analyses (hazard ratio 0.71, 95% confidence interval 0.39-1.29, P=0.259).
MLD is a gentle procedure that does not increase the risk of breast cancer recurrence in patients who develop BCRL.
本回顾性队列研究评估了手动淋巴引流（MLD）疗法是否会增加乳腺癌复发的风险。
我们分析了 1106 名 2007 年至 2011 年间被诊断为 0-3 期乳腺癌并在手术和辅助治疗后缓解的女性。患者分为两组：A 组（n=996），其中患者无论在癌症治疗后是否发生乳腺癌相关淋巴水肿（BCRL），均未参加任何 MLD 治疗；B 组（n=110），其中患者因 BCRL 参加 MLD 治疗。所有患者均接受监测，直至 2013 年 10 月，以确定是否发生乳腺癌复发，包括局部或区域复发和远处转移。在 MLD 治疗前发生癌症复发的患者被排除在分析之外。使用 Cox 比例风险模型评估与癌症复发相关的风险因素。
在监测期间，166 名患者（15.0%）发生癌症复发，A 组 154 名（15.5%），B 组 12 名（10.9%）。从手术到癌症复发的中位时间为 1.85 年（四分位距 1.18-2.93）。癌症复发的独立危险因素为组织学分级 3 级、腋窝淋巴结浸润≥3 个和肿瘤较大（>5cm）。保护因素为孕激素受体阳性和接受放射治疗。多变量分析中，MLD 治疗不是结果因素（风险比 0.71，95%置信区间 0.39-1.29，P=0.259）。
对于发生 BCRL 的患者，MLD 是一种温和的治疗方法，不会增加乳腺癌复发的风险。
