Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
Supportive Care Services, Cancer Care Alberta, Edmonton, AB, Canada.
Ann Surg Oncol. 2023 Dec;30(13):8389-8397. doi: 10.1245/s10434-023-14316-3. Epub 2023 Sep 27.
We aimed to examine potential associations between post-surgical upper limb morbidity and demographic, medical, surgical, and health-related fitness variables in newly diagnosed individuals with breast cancer.
Participants were recruited between 2012 and 2019. Objective measures of health-related fitness, body composition, shoulder range of motion, axillary web syndrome, and lymphedema were performed within 3 months of breast cancer surgery, and prior to or at the start of adjuvant cancer treatment.
Upper limb morbidity was identified in 54% of participants and was associated with poorer upper limb function and higher pain. Multivariable logistic regression analysis identified mastectomy versus breast-conserving surgery (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65-4.65), axillary lymph node dissection versus sentinel lymph node dissection (OR 2.67, 95% CI 1.73-4.10), earlier versus later time from surgery (OR 1.58, 95% CI 1.15-2.18), and younger versus older age (OR 1.01, 95% CI 1.00-1.03) as significantly associated with a higher odds of upper limb morbidity, while mastectomy (OR 1.57, 95% CI 1.10-2.25), axillary lymph node dissection (OR 2.20, 95% CI 1.34-3.60), lower muscular endurance (OR 1.10, 95% CI 1.01-1.16) and higher percentage body fat (OR 1.04, 95% CI 1.00-1.07) were significantly associated with higher odds of moderate or greater morbidity severity.
Upper limb morbidity is common in individuals after breast cancer surgery prior to adjuvant cancer treatment. Health-related fitness variables were associated with severity of upper limb morbidity. Findings may facilitate prospective surveillance of individuals at higher risk of developing upper limb morbidity.
我们旨在研究新诊断乳腺癌患者术后上肢发病率与人口统计学、医学、手术和健康相关体能变量之间的潜在关联。
参与者于 2012 年至 2019 年期间招募。在乳腺癌手术后 3 个月内，在接受辅助癌症治疗之前或开始时，对健康相关体能、身体成分、肩部活动范围、腋窝网综合征和淋巴水肿进行了客观测量。
54%的参与者出现上肢发病率，并与上肢功能较差和更高的疼痛相关。多变量逻辑回归分析确定了乳房切除术与保乳手术（比值比[OR]3.51，95%置信区间[CI]2.65-4.65）、腋窝淋巴结清扫术与前哨淋巴结活检术（OR 2.67，95%CI 1.73-4.10）、手术时间越早（OR 1.58，95%CI 1.15-2.18）和年龄越小（OR 1.01，95%CI 1.00-1.03）与上肢发病率较高显著相关，而乳房切除术（OR 1.57，95%CI 1.10-2.25）、腋窝淋巴结清扫术（OR 2.20，95%CI 1.34-3.60）、肌肉耐力越低（OR 1.10，95%CI 1.01-1.16）和体脂百分比越高（OR 1.04，95%CI 1.00-1.07）与中度或更高发病率严重程度显著相关。
在接受辅助癌症治疗之前，乳腺癌手术后的个体上肢发病率较高。健康相关体能变量与上肢发病率的严重程度相关。研究结果可能有助于对上肢发病率较高的个体进行前瞻性监测。
