乳腺癌相关淋巴水肿：危险因素的综合分析
Breast cancer-related lymphedema: A comprehensive analysis of risk factors.
作者信息
Siotos Charalampos, Arnold Sydney H, Seu Michelle, Lunt Lilia, Ferraro Jennifer, Najafali Daniel, Damoulakis George, Vorstenbosch Joshua, Mehrara Babak J, Antony Anuja K, Shenaq Deana S, Kokosis George
机构信息
Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA.
出版信息
J Surg Oncol. 2024 Dec;130(8):1521-1531. doi: 10.1002/jso.27841. Epub 2024 Aug 27.
BACKGROUND
Breast cancer-related lymphedema is a devastating condition that negatively affects the quality of life of breast cancer survivors. We sought to identify risk factors that predicted the timing and development of lymphedema.
METHODS
Women with breast cancer that underwent sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) at our institution between 2007 and 2022 were identified and sociodemographic and clinical information was extracted. We used logistic regression analysis to identify risk factors for lymphedema and performed cox-regression analysis to predict the timing of lymphedema presentation after surgery.
RESULTS
We identified 1,223 patients, of which 161 (13.2%) developed lymphedema within 1.8 (mean, SD = 2.5) years postoperatively. Patients with SLNB had significantly lower odds for lymphedema development (vs. ALND, OR = 0.29 [0.14-0.57]). Patients between 40 and 49 years of age, and 50-59 (vs. <40 years, OR = 2.14 [1.00-4.60]; OR = 2.42, [1.13-5.16] respectively), African American patients (vs. Caucasian, OR = 1.86 [1.12-3.09]), patients with stage II, III, and IV disease (vs. stage 0, OR = 3.75 [1.36-10.33]; OR = 6.62 [2.14-20.51]; OR = 9.36 [2.94-29.81]), and patients with Medicaid (vs. private insurance, OR = 3.56 [1.73-7.28]) had higher rates of lymphedema. Cox-regression analysis showed that African American (HR = 1.71 [1.08-2.70]), higher BMI (HR = 1.03 [1.00-1.06]), higher stage (stage II, HR = 2.22 [1.05-7.09]; stage III, HR = 5.26 [1.86-14.88]; stage IV, HR = 6.13 [2.12-17.75]), and Medicaid patients (HR = 2.15 [1.12-3.80]) had higher hazards for lymphedema. Patients with SLNB had lower hazards for lymphedema (HR = 0.43 [0.87-2.11]).
CONCLUSION
Lymphedema has identifiable risk factors that can reliably be used to predict the chances of lymphedema development and enable clinicians to educate patients better and formulate treatment plans accordingly.
LEVEL OF EVIDENCE
III (Retrospective study).
背景
乳腺癌相关淋巴水肿是一种严重的疾病，会对乳腺癌幸存者的生活质量产生负面影响。我们试图确定能够预测淋巴水肿发生时间和发展的风险因素。
方法
确定2007年至2022年期间在我们机构接受前哨淋巴结活检（SLNB）或腋窝淋巴结清扫（ALND）的乳腺癌女性患者，并提取社会人口统计学和临床信息。我们使用逻辑回归分析来确定淋巴水肿的风险因素，并进行cox回归分析以预测术后淋巴水肿出现的时间。
结果
我们确定了1223例患者，其中161例（13.2%）在术后1.8（平均，标准差=2.5）年内发生了淋巴水肿。接受SLNB的患者发生淋巴水肿的几率显著较低（与ALND相比，比值比=0.29[0.14-0.57]）。40至49岁以及50至59岁的患者（与<40岁相比，比值比分别为2.14[1.00-4.60]；2.42[1.13-5.16]）、非裔美国患者（与白种人相比，比值比=1.86[1.12-3.09]）、II期、III期和IV期疾病患者（与0期相比，比值比分别为3.75[1.36-10.33]；6.62[2.14-20.51]；9.36[2.94-29.81]）以及参加医疗补助计划的患者（与私人保险相比，比值比=3.56[1.73-7.28]）发生淋巴水肿的几率更高。Cox回归分析表明非裔美国人（风险比=1.71[1.08-2.70]）、较高的体重指数（风险比=1.03[1.00-1.06]）、较高分期（II期，风险比=2.22[1.05-7.09]；III期，风险比=5.26[1.86-14.88]；IV期，风险比=6.13[2.12-17.75]）以及参加医疗补助计划的患者（风险比=2.15[半开区间1.12-3.80]）发生淋巴水肿的风险更高。接受SLNB的患者发生淋巴水肿的风险较低（风险比=0.43[0.87-2.11]）。
结论
淋巴水肿具有可识别的风险因素，可用于可靠地预测淋巴水肿发生的可能性，并使临床医生能够更好地对患者进行教育并据此制定治疗计划。
证据级别
III（回顾性研究）
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