Kim Nalee, Kim Haeyoung, Hwang Ji Hye, Lee Jeong Eon, Park Won, Cho Won Kyung, Nam Seok Jin, Kim Seok Won, Yu Jonghan, Chae Byung Joo, Lee Se Kyung, Ryu Jai Min, Im Young-Hyuck, Ahn Jin Seok, Park Yeon Hee, Kim Ji-Yeon, Kim Tae-Gyu
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Physical & Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Breast Cancer. 2023 Dec;26(6):544-557. doi: 10.4048/jbc.2023.26.e43. Epub 2023 Oct 5.
Data on subsequent arm lymphedema (SAL) after salvage treatment for locoregional recurrence (LRR) of breast cancer are limited. We conducted a study to evaluate the risk of SAL in patients with LRR.
We reviewed the data of patients with breast cancer who had LRR and were initially diagnosed between January 2003 and December 2017. Among the 214 patients who received curative salvage treatment, most had local (n = 125, 57.9%), followed by regional (n = 73, 34.1%), and locoregional (n = 16, 7.9%) recurrences. A competing risk analysis considering the factors of death and a second LRR were performed to exclude potential malignant lymphedema. We used the Fine-Gray subdistribution hazards model to estimate the hazard ratio (HR) for comparing the risk of SAL.
With a median follow-up duration of 41.4 months (interquartile range, 25.6-65.1), 51 patients (23.8%) experienced SAL with a median interval of 9.9 months after treatment. The two-year cumulative incidence of SAL was 12.7%. Among the 18 patients with initial lymphedema, nine (50.0%) developed SAL. Multivariate analysis revealed that a history of lymphedema (HR, 4.61; < 0.001) and taxane-based salvage chemotherapy (HR, 2.38; = 0.009) were significantly associated with SAL development.
Salvage treatment for LRR-induced SAL was performed in 24% of the patients. A history of initial lymphedema and salvage taxane-based chemotherapy increases the risk of developing SAL. Therefore, close surveillance for the incidence of SAL is required in patients opting for salvage treatment for LRR.
乳腺癌局部区域复发（LRR）挽救性治疗后发生继发性上肢淋巴水肿（SAL）的数据有限。我们开展了一项研究以评估LRR患者发生SAL的风险。
我们回顾了2003年1月至2017年12月期间初次诊断为乳腺癌且发生LRR患者的数据。在接受根治性挽救性治疗的214例患者中，大多数为局部复发（n = 125，57.9%），其次为区域复发（n = 73，34.1%）和局部区域复发（n = 16，7.9%）。进行了一项考虑死亡因素和二次LRR的竞争风险分析以排除潜在的恶性淋巴水肿。我们使用Fine-Gray亚分布风险模型来估计比较SAL风险的风险比（HR）。
中位随访时间为41.4个月（四分位间距，25.6 - 65.1），51例患者（23.8%）发生SAL，治疗后中位间隔时间为9.9个月。SAL的两年累积发生率为12.7%。在18例初始有淋巴水肿的患者中，9例（50.0%）发生了SAL。多因素分析显示，淋巴水肿病史（HR，4.61；<0.001）和基于紫杉烷的挽救性化疗（HR，2.38；=0.009）与SAL发生显著相关。
24%的患者因LRR进行了挽救性治疗导致SAL。初始淋巴水肿病史和基于紫杉烷的挽救性化疗会增加发生SAL的风险。因此，对于选择LRR挽救性治疗的患者，需要密切监测SAL的发生率。
