From the Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
Ann Plast Surg. 2022 May 1;88(3 Suppl 3):S239-S245. doi: 10.1097/SAP.0000000000003107.
Lymphedema is an edematous condition that afflicts the postmastectomy breast cancer population, with diminished quality of life with substantial financial costs. The factors predictive of postmastectomy lymphedema development in breast cancer patients are unknown. The objective was to evaluate the trends over time in lymphedema development and the risk factors predictive of lymphedema-related events within 2 years of mastectomy.
Using the New York Statewide Planning and Research Cooperative System multicenter deidentified database from 2010 to 2016, a total of 65,543 breast cancer postmastectomy female patients (mean age, 59 ± 20 years) were identified across 177 facilities. The breast cancer patients were followed for any 2-year postmastectomy lymphedema-related events. A multivariable model identified predictors of 2-year lymphedema using eligible variables involving demographics, comorbidities, and complications. Elixhauser score was defined as a comorbidity index based on International Classification of Diseases codes used in hospital settings.
Overall, 5.2% (n = 3409) of the breast cancer postmastectomy patients experienced a lymphedema-related event within 2 years of initial surgery. Over time, 2-year postmastectomy lymphedema rates have more than doubled from 4.62% in 2010 to 9.75% in 2016 (P < 0.001). Two-year postmastectomy lymphedema rates varied significantly by mastectomy procedure type: 5.69% of the mastectomy-only procedures, 5.96% of the mastectomies with lymph node biopsies, and 7.83% of the mastectomies with lymph node dissections (P < 0.0001). Full mastectomies had a greater 2-year lymphedema rate of 7.31% when compared with partial mastectomies with 2.79% (P < 0.0001). The top predictive risk factors for a lymphedema-related event included higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P's < 0.01).
Although more recent postmastectomy lymphedema rates may not be as high as historical estimates, the 2-year postmastectomy lymphedema rates have more than doubled from 2010 to 2016 requiring further elucidation as well as continued focus on treatment. Furthermore, risk factors were identified that predispose postmastectomy breast cancer patients to developing lymphedema. Given these findings, perioperative screening seems warranted to proactively identify, educate, and monitor postmastectomy patients at greatest risk of future lymphedema development.
淋巴水肿是一种影响乳腺癌根治术后患者的水肿性疾病，生活质量下降，且耗费大量财力。目前尚不清楚乳腺癌患者发生淋巴水肿的预测因素。本研究旨在评估 2 年内乳腺癌根治术后淋巴水肿发展的趋势，并确定淋巴水肿相关事件的预测因素。
利用纽约州全州规划和研究合作系统的匿名数据库，纳入 2010 年至 2016 年间 177 家医疗机构的 65543 例乳腺癌根治术后女性患者（平均年龄 59 ± 20 岁）。随访所有患者术后 2 年内淋巴水肿相关事件。多变量模型采用涉及人口统计学、合并症和并发症的合格变量来确定 2 年内淋巴水肿的预测因素。Elixhauser 评分是一种基于医院环境中使用的国际疾病分类代码的合并症指数。
总体而言，5.2%（n=3409）的乳腺癌根治术后患者在初始手术后 2 年内发生了淋巴水肿相关事件。随着时间的推移，2 年内乳腺癌根治术后淋巴水肿发生率翻了一番以上，从 2010 年的 4.62%增至 2016 年的 9.75%（P < 0.001）。不同的乳房切除术类型的 2 年内淋巴水肿发生率差异显著：单纯乳房切除术为 5.69%，乳房切除术伴淋巴结活检为 5.96%，乳房切除术伴淋巴结清扫术为 7.83%（P < 0.0001）。与部分乳房切除术（2.79%）相比，全乳房切除术的 2 年内淋巴水肿发生率更高，为 7.31%（P < 0.0001）。淋巴水肿相关事件的最高预测风险因素包括更高的 Elixhauser 评分、乳房切除术住院时间延长、最近接受的乳房切除术、肥胖、较年轻的年龄、非亚洲种族、医疗补助保险和高血压（均 P < 0.01）。
尽管最近乳腺癌根治术后淋巴水肿的发生率可能不如历史估计的那么高，但 2010 年至 2016 年 2 年内乳腺癌根治术后淋巴水肿发生率增加了一倍以上，需要进一步阐明，并继续关注治疗。此外，还确定了导致乳腺癌根治术后患者发生淋巴水肿的风险因素。鉴于这些发现，似乎有必要进行围手术期筛查，以主动识别、教育和监测未来发生淋巴水肿风险最高的乳腺癌根治术后患者。
