高身体质量指数是乳腺癌治疗后持续性术后疼痛的潜在危险因素。

High Body Mass Index Is a Potential Risk Factor for Persistent Postoperative Pain after Breast Cancer Treatment.

机构信息

Spine & Pain Institute of New York, New York City, New York.

Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.

出版信息

Pain Physician. 2017 Jul;20(5):E661-E671.

PMID:28727711

Abstract

BACKGROUND

Risk factors associated with persistent pain after breast cancer treatment are needed to develop prevention and treatment strategies to improve the quality of life for patients with breast cancer.

OBJECTIVES

To identify factors associated with persistent pain in women undergoing breast cancer treatments.

STUDY DESIGN

Retrospective study.

SETTING

Regional hospital in the Netherlands.

METHODS

The primary outcome was pain associated with surgery at more than 6 months postoperatively and patients were stratified based on the associated visual analog" scale score they reported: reporting no pain as "no pain," pain 1 - 29 mm as "mild pain," and pain 30 - 100 mm as "moderate/severe pain." Secondary outcomes were function, symptom, and total quality of life scores. Predefined risk factors analyzed for association with outcomes included: age, smoking status, diabetes, body mass index (BMI), disease stage, surgery type, axillary lymph node dissection, reoperation, chemotherapy, radiotherapy, and hormone therapy.

RESULTS

Of the 718 patients who were approached, 492 were included (follow-up 2.5 ± 1.8 years). Thirty-five percent of patients developed persistent pain (n = 122 "mild pain," n = 53 "moderate/severe pain'"). Age, BMI, surgery type, axillary lymph node dissection, disease stage, reoperation, chemotherapy, and radiotherapy were identified as potential risk factors in univariate ordinal regression analyses (P < 0.10). Age (P < 0.01) and BMI (P = 0.04) remained independently predictive in the multivariate model. BMI and age were associated with odds ratios (ORs) of 1.04 (95% confidence intervals (CI): 1.00 - 1.08) and 0.97 (95% CI: 0.95 - 0.99), respectively per point and year increase. BMI was associated with a higher symptom score (r = 0.14, P < 0.01), a lower level of function (r = -0.11, P = 0.01), and lower total quality of life scores (r = -0.13, P < 0.01).

LIMITATIONS

The retrospective nature of this study makes it prone to response and misclassification bias.

CONCLUSIONS

BMI and age may be risk factors for persistent postoperative pain after breast cancer treatment.

KEY WORDS

Persistent postsurgical pain, breast cancer treatment, BMI, age, chronic postoperative pain, breast cancer surgery.

摘要

背景

为了制定预防和治疗策略以改善乳腺癌患者的生活质量，需要确定与乳腺癌治疗后持续疼痛相关的风险因素。

目的

确定与接受乳腺癌治疗的女性持续疼痛相关的因素。

研究设计

回顾性研究。

地点

荷兰的一家地区医院。

方法

主要结局是手术后 6 个月以上与手术相关的疼痛，患者根据报告的疼痛视觉模拟量表评分进行分层：无疼痛为“无疼痛”，疼痛 1-29 毫米为“轻度疼痛”，疼痛 30-100 毫米为“中度/重度疼痛”。次要结局为功能、症状和总生活质量评分。分析了与结局相关的预先确定的风险因素，包括：年龄、吸烟状况、糖尿病、体重指数（BMI）、疾病分期、手术类型、腋窝淋巴结清扫术、再次手术、化疗、放疗和激素治疗。

结果

在 718 名被接触的患者中，492 名患者入组（随访 2.5±1.8 年）。35%的患者出现持续性疼痛（n=122“轻度疼痛”，n=53“中度/重度疼痛”）。年龄、BMI、手术类型、腋窝淋巴结清扫术、疾病分期、再次手术、化疗和放疗在单变量有序回归分析中被确定为潜在的风险因素（P<0.10）。年龄（P<0.01）和 BMI（P=0.04）在多变量模型中仍然是独立的预测因素。BMI 和年龄每增加 1 点和 1 年，与比值比（OR）分别为 1.04（95%置信区间（CI）：1.00-1.08）和 0.97（95%CI：0.95-0.99）相关。BMI 与更高的症状评分（r=0.14，P<0.01）、更低的功能水平（r=-0.11，P=0.01）和更低的总生活质量评分（r=-0.13，P<0.01）相关。