Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Department of Radiation Oncology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Cancer Res Treat. 2016 Oct;48(4):1330-1337. doi: 10.4143/crt.2015.463. Epub 2016 Feb 3.
The purpose of this study is to identify risk factors for transient lymphedema (TLE) and persistent lymphedema (PLE) following treatment for breast cancer.
A total of 1,073 patients who underwent curative breast surgery were analyzed. TLE was defined as one episode of arm swelling that had resolved spontaneously by the next follow-up; arm swelling that persisted over two consecutive examinations was considered PLE.
At a median follow-up period of 5.1 years, 370 cases of lymphedema were reported, including 120 TLE (11.2%) and 250 PLE (23.3%). Initial grade 1 swelling was observed in 351 patients, of which 120 were limited to TLE (34%), while the other 231 progressed to PLE (66%). All initial swelling observed in TLE patients was classified as grade 1. In multivariate analysis, chemotherapy with taxane and supraclavicular radiation therapy (SCRT) were associated with development of TLE, whereas SCRT, stage III cancer and chemotherapy with taxane were identified as risk factors for PLE (p < 0.05). The estimated incidence of TLE among initial grade 1 patients was calculated using up to three treatment-related risk factors (number of dissected axillary lymph nodes, SCRT, and taxane chemotherapy). The approximate ratios of TLE and PLE based on the number of risk factors were 7:1 (no factor), 1:1 (one factor), 1:2 (two factors), and 1:3 (three factors).
One-third of initial swelling events were transient, whereas the other two-thirds of patients experienced PLE. Estimation of TLE and PLE based on known treatment factors could facilitate prediction of this life-long complication.
本研究旨在确定乳腺癌治疗后发生短暂性淋巴水肿（TLE）和持续性淋巴水肿（PLE）的风险因素。
共分析了 1073 例接受根治性乳房手术的患者。TLE 定义为一次手臂肿胀，在下一次随访时已自发消退；两次连续检查中持续存在的手臂肿胀被认为是 PLE。
在中位随访 5.1 年期间，报告了 370 例淋巴水肿病例，包括 120 例 TLE（11.2%）和 250 例 PLE（23.3%）。351 例患者最初出现 1 级肿胀，其中 120 例局限于 TLE（34%），而其余 231 例进展为 PLE（66%）。所有 TLE 患者的初始肿胀均被分类为 1 级。多变量分析显示，紫杉烷类化疗和锁骨上放射治疗（SCRT）与 TLE 的发生相关，而 SCRT、III 期癌症和紫杉烷类化疗被确定为 PLE 的风险因素（p<0.05）。使用多达三个与治疗相关的风险因素（腋窝淋巴结清扫数目、SCRT 和紫杉烷类化疗）来计算初始 1 级患者中 TLE 的估计发生率。根据风险因素的数量，TLE 和 PLE 的近似比例为 7:1（无因素）、1:1（一个因素）、1:2（两个因素）和 1:3（三个因素）。
三分之一的初始肿胀事件是短暂性的，而另外三分之二的患者发生 PLE。基于已知治疗因素估计 TLE 和 PLE 有助于预测这种终身并发症。
