Zhu Wen, Li Dan, Li Xiaoqin, Ren Jin, Chen Wenqi, Gu Hangang, Shu Yongqian, Wang Deqiang
aDepartment of Medical Oncology, The Cancer Therapy Center, Affiliated Hospital of Jiangsu University, Zhenjiang bDepartment of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Anticancer Drugs. 2017 Mar;28(3):350-355. doi: 10.1097/CAD.0000000000000468.
Docetaxel-based chemotherapy can lead to fluid retention and secondary peripheral edema of the extremities, but its association with lymphedema remains unclear. In this study, we retrospectively investigated the relationship between adjuvant docetaxel-based chemotherapy and breast cancer-related lymphedema. Patients with stage II/III breast cancer who received adjuvant chemotherapy were evaluated for lymphedema on the basis of arm circumference measurements. The incidence and risk factors of lymphedema were determined by Kaplan-Meier and Cox proportional hazard analyses. A total of 320 patients were included. Specifically, 182 patients received docetaxel and 138 patients did not receive docetaxel. Compared with docetaxel-free chemotherapy, docetaxel-based chemotherapy significantly increased the 2.5-year cumulative incidence of all-grade lymphedema (19.91 vs. 32.09%; P=0.011), which was further verified in grade 1-2 (P=0.012), but not in grade 3 lymphedema (P=0.448). Similar results were found in a comparison between docetaxel and nontaxane, but not in a comparison between docetaxel and other taxanes. Multivariate analysis showed that docetaxel-based chemotherapy is an independent risk factor for both all-grade (hazard ratio=1.73; P=0.017) and grade 1-2 lymphedema (hazard ratio=1.87; P=0.022). In conclusion, adjuvant docetaxel-based chemotherapy significantly increased the risk of breast cancer-related lymphedema.
基于多西他赛的化疗可导致液体潴留和四肢继发性外周水肿，但其与淋巴水肿的关联仍不明确。在本研究中，我们回顾性调查了辅助性基于多西他赛的化疗与乳腺癌相关淋巴水肿之间的关系。对接受辅助化疗的II/III期乳腺癌患者，根据手臂周长测量评估淋巴水肿情况。通过Kaplan-Meier法和Cox比例风险分析确定淋巴水肿的发生率和危险因素。共纳入320例患者。具体而言，182例患者接受了多西他赛治疗，138例患者未接受多西他赛治疗。与未使用多西他赛的化疗相比，基于多西他赛的化疗显著增加了所有级别淋巴水肿的2.5年累积发生率（19.91%对32.09%；P=0.011），在1-2级淋巴水肿中得到进一步验证（P=0.012），但在3级淋巴水肿中未得到验证（P=0.448）。在多西他赛与非紫杉烷类药物的比较中发现了类似结果，但在多西他赛与其他紫杉烷类药物的比较中未发现。多因素分析表明，基于多西他赛的化疗是所有级别（风险比=1.73；P=0.017）和1-2级淋巴水肿（风险比=1.87；P=0.022）的独立危险因素。总之，辅助性基于多西他赛的化疗显著增加了乳腺癌相关淋巴水肿的风险。
