Department of Surgery, Jeonbuk National University Medical School.
Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
Int J Surg. 2024 Jun 1;110(6):3518-3526. doi: 10.1097/JS9.0000000000001278.
Breast cancer-related lymphedema (BCRL) is a secondary lymphedema that occurs after breast cancer related treatments. BCRL develops from damage or dysfunction of the normally functioning lymphatic system due to surgery, radiation therapy, and rarely due to cancer recurrence. This nationwide, retrospective study was aimed at investigating the incidence and risk factors of BCRL using the database of the Korean National Health Insurance Service (NHIS).
Patients with newly diagnosed breast cancer who underwent breast surgery from 1 January 2017 to 31 December 2020, were recruited. The incidence was compared by four groups according to the operation type of breast cancer [breast conserving surgery (BCS) with sentinel lymph node biopsy (S), BCS with axillary lymph node dissection (A), total mastectomy (TM) with S, modified radical mastectomy (MRM)]. The incidence rates of lymphedema were calculated by the number of incident events by the total follow-up period. Cox proportional hazard regression was used to calculate the risk of incidence of lymphedema based on a patients' characteristics, breast cancer treatment, and comorbidities.
The final cohort of operation subjects that satisfied the inclusion criteria was 34 676. BCRL occurred in 4242 patients (12.2%), and the median follow-up period was 695.4 days. The BCRL was diagnosed in the BCS with S (8.0%), BCS with A (23.5%), TM with S (10.7%), and MRM (28.5%) with an incidence of 40.8, 132.2, 55.8, and 171.8 per 1000 person-years, respectively. Young age, obesity, chemotherapy, radiotherapy, residence in metropolitan areas, and hyperlipidemia were identified as risk factors.
In Korea, the incidence of BCRL was found to be 12.2%, with the highest risk observed among patients who underwent MRM. Therefore, surgical oncologists should meticulously assess the appropriate surgical approach and consider providing education to patients with risk factors for BCRL, aiming to ensure effective prevention strategies.
乳腺癌相关淋巴水肿（BCRL）是一种继发于乳腺癌相关治疗后的淋巴水肿。BCRL 是由于手术、放射治疗，偶尔也由于癌症复发，导致正常运作的淋巴系统受损或功能障碍而引起的。本项全国性回顾性研究旨在利用韩国国民健康保险服务（NHIS）数据库，调查 BCRL 的发生率和危险因素。
纳入 2017 年 1 月 1 日至 2020 年 12 月 31 日期间接受乳腺癌手术的新诊断乳腺癌患者。根据乳腺癌手术类型[保乳手术（BCS）联合前哨淋巴结活检（S）、BCS 联合腋窝淋巴结清扫术（A）、全乳切除术（TM）联合 S、改良根治性乳房切除术（MRM）]将患者分为四组，比较发病率。通过总随访期内的事件数计算淋巴水肿的发生率。采用 Cox 比例风险回归分析患者特征、乳腺癌治疗和合并症与淋巴水肿发病风险的关系。
最终纳入满足纳入标准的手术对象队列为 34676 例。4242 例（12.2%）患者发生 BCRL，中位随访期为 695.4 天。BCS 联合 S（8.0%）、BCS 联合 A（23.5%）、TM 联合 S（10.7%）和 MRM（28.5%）分别诊断出 40.8、132.2、55.8 和 171.8 例/1000 人年。年龄较小、肥胖、化疗、放疗、居住在大都市地区和高脂血症是发病的危险因素。
在韩国，BCRL 的发生率为 12.2%，其中行 MRM 的患者风险最高。因此，外科肿瘤医生应仔细评估适当的手术方法，并考虑向有 BCRL 风险因素的患者提供教育，旨在制定有效的预防策略。
