Warmuth M A, Bowen G, Prosnitz L R, Chu L, Broadwater G, Peterson B, Leight G, Winer E P
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Cancer. 1998 Oct 1;83(7):1362-8. doi: 10.1002/(sici)1097-0142(19981001)83:7<1362::aid-cncr13>3.0.co;2-2.
Axillary lymph node dissection is commonly performed as part of the primary management of breast carcinoma. Its value in patient management, however, has recently been questioned. Few studies exist that document long term complications.
Four hundred thirty-two patients with Stage I or II breast carcinoma who were free of recurrence 2-5 years after surgery were identified. A cross-sectional survey was conducted to determine the prevalence of long term symptoms and complications as perceived by the patient, and patient and treatment factors that may have predicted complications were determined. Three hundred thirty of the 432 (76%) completed a mailed, self-administered questionnaire. In addition, the medical records of the 330 patients were reviewed. Patient and treatment factors were analyzed with logistic regression.
Numbness was reported by 35% of patients at the time of the survey. Pain was noted in 30%, arm swelling in 15%, and limitation of arm movement in 8%. Eight percent reported episodes of infection or inflammation at some point since the diagnosis of breast carcinoma. The majority of symptoms were mild and interfered minimally with daily activities. Younger age (P=0.001) was associated with more frequent reporting of pain. Numbness was more common in younger patients (P=0.004) as well as in those with a history of smoking (P=0.012). There was a positive association of limitation of arm motion with adjuvant tamoxifen therapy (P=0.016). Arm swelling was associated with both younger age (P=0.004) and greater body surface area (P=0.008). Radiation therapy was associated with a higher frequency of infection or inflammation in the arm and/or breast (P=0.001).
Mild symptoms, especially pain and numbness, are common 2-5 years after axillary lymph node dissection. The frequency of inflammation or infection in patients treated with radiation to the breast or chest wall after an axillary lymph node dissection may be greater than previously appreciated. Severe complications or symptoms that have a major impact on daily activities are uncommon. These findings should help health care providers and their patients with breast carcinoma weigh the pros and cons of axillary lymph node dissection.
腋窝淋巴结清扫术是乳腺癌主要治疗手段的一部分。然而，其在患者治疗中的价值最近受到了质疑。很少有研究记录其长期并发症。
确定了432例I期或II期乳腺癌患者，这些患者术后2至5年无复发。进行了一项横断面调查，以确定患者所感知的长期症状和并发症的发生率，并确定可能预测并发症的患者和治疗因素。432例患者中有330例（76%）完成了邮寄的自填问卷。此外，还查阅了这330例患者的病历。采用逻辑回归分析患者和治疗因素。
在调查时，35%的患者报告有麻木感。30%的患者有疼痛，15%的患者有手臂肿胀，8%的患者有手臂活动受限。8%的患者报告自诊断乳腺癌以来曾有过感染或炎症发作。大多数症状较轻，对日常活动影响最小。年龄较小（P=0.001）与更频繁报告疼痛有关。麻木在年轻患者中更常见（P=0.004），在有吸烟史的患者中也更常见（P=0.012）。手臂活动受限与辅助性他莫昔芬治疗呈正相关（P=0.016）。手臂肿胀与年龄较小（P=0.004）和体表面积较大（P=0.008）有关。放射治疗与手臂和/或乳房感染或炎症的发生率较高有关（P=0.001）。
腋窝淋巴结清扫术后2至5年，轻度症状，尤其是疼痛和麻木很常见。腋窝淋巴结清扫术后接受乳房或胸壁放疗的患者，炎症或感染的发生率可能比之前认为的要高。严重并发症或对日常活动有重大影响的症状并不常见。这些发现应有助于医疗保健提供者及其乳腺癌患者权衡腋窝淋巴结清扫术的利弊。
