Hong Soon Woo, Kim Eun-Kyu, Shin Hee-Chul, Beom Jaewon, Lim Jae-Young, Suh Koung Jin, Kim Jee Hyun, Heo Chan Yeong, Kim Kyubo, Kim In Ah
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2025 May 25. doi: 10.1016/j.ijrobp.2025.05.062.
Breast cancer-related lymphedema (BCRL) is often challenging to manage, and knowledge of how to prevent it is limited. There are several well-known risk factors, but recent studies have also suggested the potential association of immediate breast reconstruction with lower incidence, albeit with inconclusive results. Thus, we explored the impact of immediate breast reconstruction on lymphedema incidence in patients with breast cancer who underwent a mastectomy and adjuvant radiation therapy (RT).
We retrospectively reviewed 440 patients with breast cancer who underwent a mastectomy with adjuvant RT from 2012 to 2020. Of these, 229 underwent immediate breast reconstruction (IR) group, and 211 underwent no reconstruction (NR) group. BCRL events were defined and graded on a scale of 0-3 following the International Society of Lymphology staging system. After excluding patients who experienced BCRL before RT (n = 30), with propensity score-matching, we used log-rank analysis and multivariate Cox regression models to identify associated factors. Then, the clinical course of BCRL was explored with flow diagrams.
After a median follow-up period of 35 months, 116 patients (26%) developed BCRL, with 74% classified as International Society of Lymphology stage 2-3. Two-year actuarial rate of BCRL was 16.3% for the IR group, and 28.9% for the NR group (P = .020). In a multivariate Cox regression of propensity score-matched cohort (n = 180), patients were more likely to develop stage ≥2 BCRL if ≥15 axillary lymph nodes were resected (P = .035), or intensity modulated RT was given (P = .004). However, IR was associated with a lower incidence of BCRL (P = .022). Regarding patients with initial stage 0 or 1 BCRL, the IR group showed a lower rate of progression during follow-up compared with the NR group (33% vs 60%).
In postmastectomy patients with breast cancer, resection of ≥15 axillary lymph nodes, as well as intensity modulated RT, were found to be significantly associated with lymphedema occurrence. Notably, IR may be associated with a lower incidence of lymphedema.
乳腺癌相关淋巴水肿（BCRL）的管理通常具有挑战性，且关于如何预防它的知识有限。存在几个众所周知的风险因素，但最近的研究也表明即刻乳房重建与较低的发病率可能相关，尽管结果尚无定论。因此，我们探讨了即刻乳房重建对接受乳房切除术和辅助放疗（RT）的乳腺癌患者淋巴水肿发生率的影响。
我们回顾性分析了2012年至2020年间440例行乳房切除术并接受辅助放疗的乳腺癌患者。其中，229例接受了即刻乳房重建（IR）组，211例未进行重建（NR）组。根据国际淋巴学会分期系统，将BCRL事件定义并按0 - 3级进行分级。在排除放疗前已发生BCRL的患者（n = 30）后，通过倾向得分匹配，我们使用对数秩分析和多变量Cox回归模型来确定相关因素。然后，用流程图探讨BCRL的临床过程。
中位随访期35个月后，116例患者（26%）发生了BCRL，其中74%被归类为国际淋巴学会2 - 3期。IR组BCRL的两年精算发生率为16.3%，NR组为28.9%（P = 0.020）。在倾向得分匹配队列（n = 180）的多变量Cox回归分析中，如果切除≥15个腋窝淋巴结（P = 0.035）或给予调强放疗（P = 0.004），患者发生≥2期BCRL的可能性更大。然而，IR与BCRL的较低发生率相关（P = 0.022）。对于初始为0或1期BCRL的患者，IR组在随访期间的进展率低于NR组（33%对60%）。
在乳腺癌乳房切除术后患者中，发现切除≥15个腋窝淋巴结以及调强放疗与淋巴水肿的发生显著相关。值得注意的是，IR可能与较低的淋巴水肿发生率相关。
