Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.
School of Computer Science, Wuhan University, Wuhan, Hubei, People's Republic of China.
Ann Surg Oncol. 2021 Nov;28(12):7319-7328. doi: 10.1245/s10434-021-09982-0. Epub 2021 Apr 23.
Preoperatively determining those patients who are at high risk of encountering breast cancer-related lymphedema (BCRL) is still not well understood.
This study aimed to develop a simple intraoperative nomogram for BCRL, incorporating a protective factor.
Overall, 320 breast cancer patients at Zhongnan Hospital (training set) and 221 patients at Dongfeng General Hospital (external validation cohort) treated between November 2017 and December 2018 were included. Prior to axillary lymph node dissection (ALND), 1 mL (2.5 mg) of indocyanine green was administered to the area of the internal bicipital sulcus of the upper limb. The fluorescence image was obtained and the proportion of arm lymph flow above the level of the axillary vein was calculated. Multivariate logistic regression was performed using this proportion together with clinical data. A nomogram was then constructed and assessed for its discrimination and calibration ability and clinical utility in the training and external validation sets.
The cumulative incidence of BCRL was 18.7% (60/320), with a median follow-up of 29 months (20-34). In the multivariate logistic regression analysis, body mass index, taxane, radiotherapy, and proportion of arm lymph flow above the level of the axillary vein were identified as independent risk factors. In the training and validation cohorts, the calibration curve performed well (p = 0.721 and p = 0.315, respectively), and the area under the receiver operating characteristic curve values were 0.829 (95% confidence interval [CI] 0.773-0.885) and 0.804 (95% CI 0.732-0.877), respectively.
High-risk patients could be identified intraoperatively with this nomogram, and timely intervention could be performed with preservation of the arm lymphatics.
目前，临床上尚无法准确预测哪些乳腺癌患者术后会发生乳腺癌相关淋巴水肿（BCRL）。
本研究旨在建立一种简单的术中 BCRL 风险预测列线图，纳入一个保护因素。
本研究纳入 2017 年 11 月至 2018 年 12 月期间于我院（训练集）和东风总医院（外部验证队列）接受治疗的 320 例乳腺癌患者和 221 例患者。在进行腋窝淋巴结清扫术（ALND）前，于上肢肱二头肌内沟区域注射 1ml（2.5mg）吲哚菁绿。获取荧光图像并计算上肢臂淋巴流量高于腋静脉水平的比例。使用该比例和临床数据进行多变量 logistic 回归分析。然后构建并评估该列线图在训练集和外部验证集中的鉴别能力、校准能力和临床实用性。
320 例患者中，60 例（18.7%）发生 BCRL，中位随访时间为 29 个月（20-34 个月）。多变量 logistic 回归分析显示，体质量指数、紫杉烷类药物、放疗和上肢臂淋巴流量高于腋静脉水平的比例是 BCRL 的独立危险因素。在训练集和验证集中，校准曲线表现良好（p=0.721 和 p=0.315），受试者工作特征曲线下面积分别为 0.829（95%置信区间 [CI]：0.773-0.885）和 0.804（95% CI：0.732-0.877）。
通过该列线图可在术中识别高危患者，并通过保留上肢淋巴管进行及时干预。
