Soran Atilla, Menekse Ebru, Girgis Mark, DeGore Lori, Johnson Ronald
Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, 300 Halket St, Ste 2601, Pittsburgh, PA, USA.
Support Care Cancer. 2016 Mar;24(3):1413-9. doi: 10.1007/s00520-015-2933-0. Epub 2015 Sep 9.
Early detection and timely intervention demonstrate the greatest promise of reducing the incidence of late-stage lymphedema in breast cancer patients undergoing axillary lymph node dissection (ALND). A nomogram was developed for predicting the risk of lymphedema (LE) in patients with ALND. This study's aim was to test the early postoperative prediction model for the diagnosis of clinical and subclinical LE after ALND.
Patients requiring ALND were identified preoperatively through our LE program database. Measurements using metered tape with bioimpedance spectroscopy (L-Dex U400) were obtained preoperatively (n = 180) and at 3-6-month intervals postoperatively. The 5-year probability of LE after ALND was calculated using the Cleveland Clinic Risk Calculator. The discrimination of the nomogram was assessed by calculating the area under (AUC) the receiver operating characteristic curve.
LE was present in 36.1% (n = 65) of 180 patients with ALND. Of these 65 patients, 22 (12.2%) had clinical LE and 43 (23.9%) had subclinical LE. Statistical analyses showed significant differences in BMI and receipt of radiotherapy between patients with and without LE (p = 0.03 and p = 0.01, respectively). AUC was 0.601, 0.614, and 0.600 for the nomogram using any LE, clinical LE, and subclinical LE patients, respectively.
The recently created prediction model for the diagnosis of LE in ALND is not accurate in predicting who will develop clinical or subclinical LE. Periodic monitoring of women with ALND is the most effective method to aid in reducing clinical LE incidence through early detection and timely intervention of LE.
早期发现和及时干预对于降低接受腋窝淋巴结清扫术（ALND）的乳腺癌患者晚期淋巴水肿的发生率最具前景。我们开发了一种列线图来预测接受ALND患者发生淋巴水肿（LE）的风险。本研究的目的是测试该术后早期预测模型在诊断ALND术后临床和亚临床LE方面的效果。
通过我们的LE项目数据库在术前确定需要接受ALND的患者。术前（n = 180）以及术后每隔3 - 6个月使用带生物电阻抗光谱的卷尺（L - Dex U400）进行测量。使用克利夫兰诊所风险计算器计算ALND术后LE的5年概率。通过计算受试者操作特征曲线下面积（AUC）来评估列线图的辨别能力。
180例接受ALND的患者中有36.1%（n = 65）发生了LE。在这65例患者中，22例（12.2%）有临床LE，43例（23.9%）有亚临床LE。统计分析显示，有LE和无LE的患者在BMI和放疗接受情况方面存在显著差异（分别为p = 0.03和p = 0.01）。使用任何LE、临床LE和亚临床LE患者的列线图的AUC分别为0.601、0.614和0.600。
最近创建的用于诊断ALND术后LE的预测模型在预测谁会发生临床或亚临床LE方面并不准确。对接受ALND的女性进行定期监测是通过早期发现和及时干预LE来降低临床LE发生率的最有效方法。
