RESUMO
PURPOSE: To investigate the incidence rate, severity and risk factors of related lymphedema in breast cancer survivors. METHODS: A 2-year follow-up prospective study of 387 women who had operation from four hospitals from January 1, to December 31, 2014 was conducted. Limb volume was measured by circumference and symptoms were measured using questionnaires pre-treatment and 1, 3, 6, 12, 18, 24 months after surgery separately. The incidence rates and the severity of lymphedema were evaluated, respectively. Risk factors for the development of breast cancer-related lymphedema (BCRL) were analyzed using log-rank test and Cox regression. RESULTS: The incidences of BCRL were 4.4, 10.1, 15.2, 28.6, 31.2 and 32.5% at 1, 3, 6, 12, 18, 24 months after surgery, respectively, measured by Norman questionnaire. The rates measured by arm circumference were 2.5, 6.7, 13.4, 21.4, 26.3 and 29.4%, respectively. About 114 (29.4% of 387) women were diagnosed with BCRL, and 78 of them got mild lymphedema. Axillary lymph node dissection (ALND) (HR = 5.2, 95% CI 1.6-17.3), radiotherapy (HR = 3.9, 95% CI 2.0-7.5), modified radical mastectomy (MRM) (HR = 2.1, 95% CI 1.3-3.4), the number of positive lymph nodes (HR = 1.1, 95% CI 1.0-1.2) and body mass index (BMI) (HR = 1.1, 95% CI 1.0-1.1) were independent risk factors for BCRL. CONCLUSIONS: BCRL is a common complication for breast cancer patients after surgery. It can be fairly diagnosed only 1 month post-operation and the cumulative incidence of BCRL seems to be increasing over time, especially in the first year after surgery. ALND, radiotherapy, MRM, the number of positive axillary lymph nodes and BMI were found to be independent risk factors in the development of BCRL in this study.
Assuntos
Linfedema Relacionado a Câncer de Mama/epidemiologia , Neoplasias da Mama/terapia , Sobreviventes de Câncer/estatística & dados numéricos , Excisão de Linfonodo/efeitos adversos , Mastectomia/efeitos adversos , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila/cirurgia , Mama/patologia , Mama/cirurgia , Linfedema Relacionado a Câncer de Mama/etiologia , Neoplasias da Mama/patologia , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Mastectomia/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
BACKGROUND: To evaluate risk factors for upper extremity lymphedema due to breast cancer surgery. MATERIALS AND METHODS: Clinical studies published on PubMed, Ovid, EMbase, and Cochrane Library from January 1996 to December 2012 were selected. RESULTS: Twenty-five studies were identified, including 12,104 patients. Six risk factors related to the incidence of lymphedema after breast cancer treatment were detected: axillary lymph node dissection (OR=3.73, 95%CI 1.16 to 11.96), postoperative complications (OR=2.64, 95%CI 1.10 to 6.30), hypertension (OR=1.83, 95%CI 1.38 to 2.42), high body mass index (OR=1.80, 95%CI 1.30 to 2.49), chemotherapy (OR=1.38, 95%CI 1.07 to 1.79) and radiotherapy (OR=1.35, 95%CI 1.10 to 1.66). We found significant protective factors for lymphedema: pathologic T classification (OR=0.57, 95%CI 0.36 to 0.91) and stage (OR=0.60, 95%CI 0.39 to 0.93), while some factors, like age, number of positive lymph nodes, number of lymph node dissection, demonstrated no obvious correlation. CONCLUSIONS: Axillary lymph node dissection, postoperative complications, hypertension, body mass index, chemotherapy, radiotherapy are risk factors for lymphedema after breast cancer treatment. Attention should be paid to patients with risk factors to prevent the occurrence of lymphedema.
