Rubin Jonathan, Pollack Bracha, Coleman-Belin Janet, Campbell Adana-Christine, Roberts Arielle, Wagner Benjamin D, Kataru Raghu P, Boe Lillian, Barrio Andrea V, Mehrara Babak J
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
J Am Coll Surg. 2025 May 5. doi: 10.1097/XCS.0000000000001434.
Over 30% of breast cancer patients develop lymphedema following axillary lymph node dissection (ALND), significantly impacting their quality of life. Comorbid conditions like diabetes mellitus (DM), which contribute to endothelial dysfunction and inflammation, may also affect lymphatic endothelium. Preclinical studies suggest that metformin, a common DM treatment, may reduce lymphedema risk.
We conducted a retrospective analysis of breast cancer patients at Memorial Sloan Kettering Cancer Center who underwent ALND from January 2004 through December 2022 (4,882 patients overall). We stratified patients according to if they were diagnosed with DM at the time of surgery, and if so, if they were receiving metformin. We also conducted univariable and multivariable analyses of patient demographics for the overall cohort and the metformin vs no-metformin DM subgroups.
Of the 407 patients with diabetes at the time of ALND, 250 (61%) were receiving metformin and 157 (39%) were not. While having diabetes at the time of ALND was a significant risk factor for lymphedema on univariable (HR: 1.38; 95% CI: 1.14, 1.66; P < .001) and multivariable (HR: 1.55; 95% CI: 1.19, 2.02; P = .001) analysis, metformin treatment was associated with a significant decrease in lymphedema risk (univariable HR: 0.66; 95% CI: 0.46, 0.94; P = .023; multivariable HR: 0.62; 95% CI: 0.43, 0.89; P = .010).
Diabetic breast cancer patients have a significantly increased risk of developing lymphedema after ALND; however, those using metformin at the time of surgery had a lower incidence compared to non-users.
超过30%的乳腺癌患者在腋窝淋巴结清扫术（ALND）后会发生淋巴水肿，这对他们的生活质量有显著影响。糖尿病（DM）等合并症会导致内皮功能障碍和炎症，也可能影响淋巴管内皮。临床前研究表明，常见的糖尿病治疗药物二甲双胍可能会降低淋巴水肿风险。
我们对纪念斯隆凯特琳癌症中心2004年1月至2022年12月期间接受ALND的乳腺癌患者进行了回顾性分析（共4882例患者）。我们根据患者在手术时是否被诊断为糖尿病，以及如果是，是否正在接受二甲双胍治疗进行分层。我们还对整个队列以及二甲双胍治疗组与未使用二甲双胍的糖尿病亚组的患者人口统计学进行了单变量和多变量分析。
在407例ALND时患有糖尿病的患者中，250例（61%）正在接受二甲双胍治疗，157例（39%）未接受。虽然ALND时患有糖尿病在单变量（HR：1.38；95%CI：1.14，1.66；P<.001）和多变量（HR：1.55；95%CI：1.19，2.02；P=.001）分析中是淋巴水肿的显著危险因素，但二甲双胍治疗与淋巴水肿风险的显著降低相关（单变量HR：0.66；95%CI：0.46，0.94；P=.023；多变量HR：0.62；95%CI：0.43，0.89；P=.010）。
糖尿病乳腺癌患者在ALND后发生淋巴水肿的风险显著增加；然而，手术时使用二甲双胍的患者与未使用者相比，发病率较低。
