Kim Asall, Yi Chunghwi, Ji Myungki, Hwang Ui-Jae, Lim Jae-Young, Myung Yujin, Choi Eun Joo, Shin Hee-Chul, Beom Jaewon
Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea.
Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Gangwon-do, Republic of Korea.
PLoS One. 2025 Jun 12;20(6):e0326119. doi: 10.1371/journal.pone.0326119. eCollection 2025.
The relationship between postoperative physical changes and the development of homolateral neuropathic pain (HLNP) following mastectomy and lymph node resection remains poorly understood. In this study, we aimed to investigate whether early postoperative physical and symptom-based assessments could predict HLNP occurrence at 4 months post-surgery. Fifty-seven breast cancer survivors were included, with HLNP defined as a painDETECT Questionnaire score ≥ 13 at 4 months. Independent variables included patient demographics, physical function metrics including pectoralis minor length index (PMI), and questionnaire-based evaluations at 1 month postoperatively. Multivariate logistic regression identified systemic therapy side effects (ST) (odds ratio [OR]: 1.056; 95% confidence interval [CI]: 1.015-1.098) and PMI (OR: 0.204; 95% CI: 0.043-0.977) as significant predictors of HLNP. Receiver operating characteristic curve analysis identified cutoff values of 23.81 for ST and 9.82 for PMI. Reconstruction type and adjuvant therapy influenced the correlation between PMI and the number of resected lymph nodes, unlike external rotation metrics. Early assessment of ST and PMI facilitates HLNP risk prediction following breast cancer surgery. Multimodal interventions, including targeted physical therapy, may mitigate HLNP risk, highlighting the importance of early postoperative care.
乳房切除术和淋巴结切除术后的身体变化与同侧神经性疼痛（HLNP）的发生之间的关系仍未得到充分了解。在本研究中，我们旨在调查术后早期基于身体和症状的评估是否能够预测术后4个月时HLNP的发生情况。纳入了57名乳腺癌幸存者，HLNP定义为术后4个月时疼痛检测问卷评分≥13分。自变量包括患者人口统计学特征、身体功能指标（包括胸小肌长度指数（PMI））以及术后1个月时基于问卷的评估。多变量逻辑回归确定全身治疗副作用（ST）（比值比[OR]：1.056；95%置信区间[CI]：1.015 - 1.098）和PMI（OR：0.204；95%CI：0.043 - 0.977）是HLNP的显著预测因素。受试者工作特征曲线分析确定ST的截断值为23.81，PMI的截断值为9.82。与外旋指标不同，重建类型和辅助治疗影响了PMI与切除淋巴结数量之间的相关性。对ST和PMI的早期评估有助于预测乳腺癌手术后HLNP的风险。包括针对性物理治疗在内的多模式干预可能会降低HLNP风险，突出了术后早期护理的重要性。
