Das Nandita, Baumgartner Richard N, Riley Elizabeth C, Pinkston Christina M, Yang Dongyan, Baumgartner Kathy B
Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, 40202, USA.
J Cancer Surviv. 2015 Sep;9(3):422-30. doi: 10.1007/s11764-014-0416-9. Epub 2015 Apr 26.
Treatment-related factors may increase the risk for arm lymphedema, which may occur after surgery or even many years after initial treatment for breast cancer. The association between treatment-related risk factors and development of arm lymphedema was examined for women who participated in the long-term quality of life (LTQOL) study, a 12-15-year follow-up of a breast cancer case-control study of Hispanic and non-Hispanic white women.
Among 199 cases, 43 women (15 Hispanic, 28 non-Hispanic white) reported physician-diagnosed lymphedema during follow-up. Multivariable logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for the association of risk factors with lymphedema, adjusting for relevant covariates.
Tamoxifen had a non-significant, positive association with lymphedema (OR = 2.07, 95% CI 0.94-4.55, p =0.07). There were no significant associations with type of surgery, radiation, or chemotherapy. Risk was increased specifically in overweight and obese women (body mass index (BMI) > =25 kg/m(2)) treated with tamoxifen (OR = 2.62, 95% CI 0.99-6.93, p = 0.05).
This study suggests that breast cancer survivors with a BMI >25 who report the use of tamoxifen therapy may be at increased risk for arm lymphedema.
Larger case-control studies and clinical trials should investigate the long-term association of tamoxifen treatment with arm lymphedema especially in overweight and obese women. Lymphedema risk may be another indication to consider a weight reduction program in breast cancer survivors.
与治疗相关的因素可能会增加手臂淋巴水肿的风险，这种情况可能在乳腺癌手术后出现，甚至在初始治疗后的许多年也可能发生。对于参与长期生活质量（LTQOL）研究的女性，我们研究了与治疗相关的风险因素和手臂淋巴水肿发生之间的关联，该研究是对西班牙裔和非西班牙裔白人女性乳腺癌病例对照研究进行的12至15年随访。
在199例病例中，43名女性（15名西班牙裔，28名非西班牙裔白人）在随访期间报告了医生诊断的淋巴水肿。多变量逻辑回归分析用于计算风险因素与淋巴水肿关联的比值比（OR）和95%置信区间（CI），并对相关协变量进行调整。
他莫昔芬与淋巴水肿呈非显著的正相关（OR = 2.07，95% CI 0.94 - 4.55，p = 0.07）。与手术类型、放疗或化疗无显著关联。在接受他莫昔芬治疗的超重和肥胖女性（体重指数（BMI）≥25 kg/m²）中，风险尤其增加（OR = 2.62，95% CI 0.99 - 6.93，p = 0.05）。
本研究表明，BMI>25且报告使用他莫昔芬治疗的乳腺癌幸存者可能患手臂淋巴水肿的风险增加。
更大规模的病例对照研究和临床试验应调查他莫昔芬治疗与手臂淋巴水肿的长期关联，尤其是在超重和肥胖女性中。淋巴水肿风险可能是乳腺癌幸存者考虑减肥计划的另一个指征。
