Wang Ling, Chen Hongbo, Li Yuanzhen, Wang Huixue, Liu Ning, Yu Miao, Shang Shaomei
School of Nursing, Wannan Medical College, Wuhu, 241002, China.
School of Nursing, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China.
Support Care Cancer. 2023 Apr 19;31(5):278. doi: 10.1007/s00520-023-07721-7.
Breast cancer-related lymphedema (BCRL) is an incurable complication occurring after breast cancer treatment. The influence of obesity/overweight on the development of BCRL at different points after surgery was seldom verified. We aimed to determine the cut-off BMI/weight value associated with an increased risk of BCRL at different postoperative time in Chinese breast cancer survivors.
Patients who underwent breast surgery plus axillary lymph node dissection (ALND) were retrospectively evaluated. Disease and treatment characteristics of participants were collected. BCRL was diagnosed by circumference measurements. Univariate and multivariable logistic regression was used to assess the relationship of lymphedema risk with BMI/weight and other disease- and treatment-related factors.
518 patients were included. Lymphedema occurred more frequently among breast cancer patients with preoperative BMI ≥ 25 kg/m (37.88%) than among those with preoperative BMI < 25 kg/m(23.32%), with significant differences at 6-12 and 12-18 months after surgery (χ = 23.183, P = 0.000; χ = 5.279, P = 0.022). By multivariable logistics analysis, preoperative BMI ≥ 30 kg/m presented a significantly greater risk of lymphedema than a preoperative BMI < 25 kg/m (OR [95% CI] = 2.928 [1.565, 5.480]). Other factors, including radiation (breast/chest wall + axilla vs. none: OR [95% CI] = 3.723[2.271-6.104]), was an independent risk factor for lymphedema.
Preoperative obesity was an independent risk factor for BCRL in Chinese breast cancer survivors, and a preoperative BMI ≥ 25 kg/m indicated greater likelihood of lymphedema development within 6-18 months postoperatively.
乳腺癌相关淋巴水肿（BCRL）是乳腺癌治疗后出现的一种无法治愈的并发症。肥胖/超重对术后不同时间点BCRL发生发展的影响鲜有验证。我们旨在确定中国乳腺癌幸存者术后不同时间与BCRL风险增加相关的体重指数（BMI）/体重临界值。
对接受乳房手术加腋窝淋巴结清扫术（ALND）的患者进行回顾性评估。收集参与者的疾病和治疗特征。通过测量周长诊断BCRL。采用单因素和多因素逻辑回归分析评估淋巴水肿风险与BMI/体重及其他疾病和治疗相关因素之间的关系。
共纳入518例患者。术前BMI≥25kg/m²的乳腺癌患者发生淋巴水肿的频率（37.88%）高于术前BMI<25kg/m²的患者（23.32%），在术后6 - 12个月和12 - 18个月时有显著差异（χ² = 23.183，P = 0.000；χ² = 5.279，P = 0.022）。多因素逻辑分析显示，术前BMI≥30kg/m²的患者发生淋巴水肿的风险显著高于术前BMI<25kg/m²的患者（比值比[95%置信区间]=2.928[1.565, 。其他因素，包括放疗（乳房/胸壁+腋窝放疗与未放疗：比值比[95%置信区间]=3.723[2. , 6.104]），是淋巴水肿的独立危险因素。
术前肥胖是中国乳腺癌幸存者发生BCRL的独立危险因素，术前BMI≥25kg/m²表明术后6 - 18个月内发生淋巴水肿的可能性更大。
