Department of Surgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea.
Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Breast Cancer. 2018 Feb;18(1):e49-e54. doi: 10.1016/j.clbc.2017.06.003. Epub 2017 Jun 21.
The aim of our study was to analyze the risk of lymphedema (LE) according to the clinicopathologic factors and to investigate the serial change in body weight during neoadjuvant anthracycline plus cyclophosphamide followed by taxane and its correlation with the incidence of LE.
We performed a retrospective 2-center study of 406 patients who had undergone neoadjuvant chemotherapy (NAC) followed by surgery from 2007 to 2014. The regimen included 4 cycles of anthracycline plus cyclophosphamide, followed by 4 cycles of taxane. We investigated the presence and degree of LE using a telephone questionnaire assessment. Weight changes were calculated at each cycle of NAC, and the baseline and preoperative body weights were used to calculate the rate of change to account for the change in weight before and after NAC.
Of the 406 patients, 270 answered the questionnaires, of whom 97 (35.9%) experienced LE. The increase in body weight was significant during the 4 cycles of taxane, but the change in weight was not significant during the 4 cycles of anthracycline plus cyclophosphamide. The change in body weight was most significant just after the fourth cycle of taxane (P < .001). The body mass index (BMI) was an independent factor of LE occurrence on multivariate analysis. However, the change in body weight was not a significant factor for the incidence of LE.
Because a BMI ≥ 25 kg/m was an independent factor of LE occurrence on multivariate analysis, patients with a preoperative BMI ≥ 25 kg/m should be closely monitored for LE given their increased risk, and monitoring and education should be initiated before surgery and continued throughout the course of NAC.
我们的研究目的是分析临床病理因素与腋窝淋巴水肿（LE）风险的关系，并探讨新辅助蒽环类加环磷酰胺序贯紫杉烷治疗期间体重的变化及其与 LE 发生率的关系。
我们对 2007 年至 2014 年间接受新辅助化疗（NAC）后手术的 406 例患者进行了回顾性的 2 中心研究。方案包括 4 周期蒽环类加环磷酰胺，然后是 4 周期紫杉烷。我们使用电话问卷调查评估 LE 的存在和程度。计算 NAC 每周期的体重变化，并使用基线和术前体重计算变化率，以考虑 NAC 前后体重的变化。
在 406 例患者中，有 270 例回答了问卷，其中 97 例（35.9%）发生了 LE。在 4 个周期的紫杉烷治疗期间，体重增加明显，但在蒽环类加环磷酰胺的 4 个周期中，体重变化不明显。体重变化在第四周期紫杉烷后最为明显（P<0.001）。体重指数（BMI）是多因素分析中 LE 发生的独立因素。然而，体重变化不是 LE 发生率的显著因素。
由于 BMI≥25 kg/m2是多因素分析中 LE 发生的独立因素，对于术前 BMI≥25 kg/m2的患者，由于其风险增加，应密切监测 LE，并在手术前开始监测和教育，并在 NAC 过程中持续进行。
