Casella Donato, Rocco Nicola, Sordi Silvia, Catanuto Giuseppe, Toesca Antonio, Sanvitale Luca, Barbiero Michele, Bergamasco Laura, Ribuffo Diego, Ferrando Pietro Maria, Kaciulyte Juste
Oncologic Breast Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Eur J Surg Oncol. 2025 Jul;51(7):109754. doi: 10.1016/j.ejso.2025.109754. Epub 2025 Mar 7.
Nowadays, physicians have tools to prevent breast cancer-related lymphedema (BCRL) but there is no consensus on when to apply them. The authors analysed patient- and treatment-related risk factors to create the LyBra score, to identify patients that may benefit the most from BCRL preventive interventions.
Patients were selected from cases of breast cancer treated from January 2019 to July 2022. Inclusion criteria were age above 18, breast cancer diagnosis and surgical treatment with lymph-node biopsy or axillary dissection. Recurrent cancers, inflammatory cancer, previous axillary surgery, bilateral cases and patients with primary lymphedema were excluded. Selected cases were assessed with the LyBra Score. Numerosity and distribution of expected BCRL were compared to the BCRL registered during the minimum follow-up of 2 years.
During an average 41 months follow-up (range, 24-62), 131 cases (14 %) of BCRL were registered in the total 933 patients included in the study. According to LyBra score, expected BCRL cases were 149 (16 %), slightly higher but with no statistical significance. The major incidence of BCRL (40 cases in 47 patients) was registered in the high-risk group that included 5 % of the study population. A ROC curve was used to determine the diagnostic performance of the LyBra score and the AUC was 0.78 corresponding to a good discriminating ability.
By sorting patients into risk groups, the LyBra score offers a solution to the actual dilemma of timing and indication of the modern preventive-BCRL microsurgeries.
如今，医生拥有预防乳腺癌相关淋巴水肿（BCRL）的工具，但对于何时应用这些工具尚无共识。作者分析了与患者和治疗相关的风险因素，以创建LyBra评分，从而识别可能从BCRL预防干预措施中获益最大的患者。
从2019年1月至2022年7月接受治疗的乳腺癌病例中选取患者。纳入标准为年龄在18岁以上、乳腺癌诊断以及接受淋巴结活检或腋窝清扫的手术治疗。复发性癌症、炎性癌、既往腋窝手术史、双侧病例以及原发性淋巴水肿患者被排除。对选定病例进行LyBra评分评估。将预期BCRL的数量和分布与在至少2年的最短随访期间记录的BCRL进行比较。
在平均41个月的随访期间（范围为24 - 62个月），在纳入研究的933例患者中，共记录到131例（14%）BCRL病例。根据LyBra评分，预期BCRL病例为149例（16%），略高但无统计学意义。BCRL的主要发病率（47例患者中的40例）出现在高危组，该组占研究人群的5%。使用ROC曲线确定LyBra评分的诊断性能，AUC为0.78，表明具有良好的鉴别能力。
通过将患者分为风险组，LyBra评分为现代预防性BCRL显微手术的时机和适应症这一实际困境提供了解决方案。
