新辅助化疗和腋窝清扫术后乳腺癌幸存者的淋巴水肿症状和肢体测量变化：美国外科医师学院肿瘤学组（ACOSOG）Z1071（联盟）子研究结果。
Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy.
机构信息
University of Missouri Sinclair School of Nursing, Columbia, MO, 65211, USA.
Alliance Statistics and Data Center, Weill Cornell Medicine, New York, NY, USA.
出版信息
Support Care Cancer. 2019 Feb;27(2):495-503. doi: 10.1007/s00520-018-4334-7. Epub 2018 Jul 6.
PURPOSE
Lymphedema is a potential complication of breast cancer treatment. This longitudinal substudy aimed to prospectively assess arm measurements and symptoms following neoadjuvant chemotherapy and axillary dissection in the ACOSOG/Alliance Z1071 trial to characterize the optimal approach to define lymphedema.
METHODS
Z1071 enrolled patients with cT0-4, N1-2, M0 disease treated with neoadjuvant chemotherapy. All patients underwent axillary dissection. Bilateral limb volumes, circumferences, and related symptoms were assessed pre-surgery, 1-2 weeks post-surgery, and semiannually for 36 months. Lymphedema definitions included volume increase ≥ 10% or limb circumference increase ≥ 2 cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire.
RESULTS
In 488 evaluable patients, lymphedema incidence at 3 years by ≥ 10%-volume-increase was 60.3% (95% CI 55.0-66.2%) and by ≥ 2 cm-circumference increase was 75.4% (95% CI 70.8-80.2%). Symptoms of arm swelling and heaviness decreased from post-surgery for the first 18 months and then were relatively stable. The 3-year cumulative incidence of arm swelling and heaviness was 26.0% (95% CI 21.7-31.1%) and 30.9% (95% CI 26.3-36.3%), respectively. There was limited agreement between the two measurements (kappa 0.27) and between symptoms and measurements (kappa coefficients ranging from 0.05-0.09).
CONCLUSIONS
Lymphedema incidence by limb volume and circumference gradually increased over 36 months post-surgery, whereas lymphedema symptoms were much lower. These findings underscore the importance of prospective surveillance and evaluation of both limb measurements and symptom assessment. Lymphedema incidence rates varied by definition. We recommend that ≥ 10% volume change criterion be used for lymphedema evaluation for referral for specialist care.
TRIAL REGISTRATION
NCT00881361.
目的
淋巴水肿是乳腺癌治疗的潜在并发症。本纵向亚研究旨在前瞻性评估 ACOSOG/Alliance Z1071 试验中接受新辅助化疗和腋窝清扫术的患者的手臂测量值和症状，以确定淋巴水肿的最佳定义方法。
方法
Z1071 纳入了接受新辅助化疗的 cT0-4、N1-2、M0 疾病的患者。所有患者均接受腋窝清扫术。在术前、术后 1-2 周以及术后 36 个月每半年评估双侧肢体体积、周长和相关症状。淋巴水肿的定义包括体积增加≥10%或肢体周长增加≥2cm。通过淋巴水肿乳腺癌问卷评估症状。
结果
在 488 例可评估患者中，3 年时体积增加≥10%的淋巴水肿发生率为 60.3%（95%CI，55.0-66.2%），周长增加≥2cm 的淋巴水肿发生率为 75.4%（95%CI，70.8-80.2%）。手臂肿胀和沉重的症状在术后前 18 个月逐渐减轻，然后相对稳定。3 年时手臂肿胀和沉重的累积发生率分别为 26.0%（95%CI，21.7-31.1%）和 30.9%（95%CI，26.3-36.3%）。两种测量方法之间的一致性有限（kappa 值为 0.27），症状与测量值之间的一致性也有限（kappa 值范围为 0.05-0.09）。
结论
术后 36 个月内，肢体体积和周长的淋巴水肿发生率逐渐增加，而淋巴水肿症状要低得多。这些发现强调了前瞻性监测和评估肢体测量值和症状评估的重要性。淋巴水肿的发生率因定义而异。我们建议使用≥10%体积变化标准来评估淋巴水肿，以便为患者转介至专科治疗。
试验注册
NCT00881361。
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